Provider Demographics
NPI:1598827891
Name:VAN DER SWAAGH, PEGGY B (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:B
Last Name:VAN DER SWAAGH
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:188 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:KILLINGWORTH
Mailing Address - State:CT
Mailing Address - Zip Code:06419-2238
Mailing Address - Country:US
Mailing Address - Phone:860-663-2623
Mailing Address - Fax:
Practice Address - Street 1:214B THAMES ST
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-3632
Practice Address - Country:US
Practice Address - Phone:860-449-1382
Practice Address - Fax:860-449-1384
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist