Provider Demographics
NPI:1609461987
Name:HARDELL, PETER ANDREW
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ANDREW
Last Name:HARDELL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 W SOUTH ORANGE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-1728
Mailing Address - Country:US
Mailing Address - Phone:973-688-8857
Mailing Address - Fax:973-368-8859
Practice Address - Street 1:10 W SOUTH ORANGE AVE FL 2
Practice Address - Street 2:
Practice Address - City:SOUTH ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07079-1728
Practice Address - Country:US
Practice Address - Phone:973-688-8857
Practice Address - Fax:973-368-8859
Is Sole Proprietor?:No
Enumeration Date:2021-03-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00088600101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional