Provider Demographics
NPI:1619943735
Name:SWARTZ, PETER JOSEPH (PSYD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:JOSEPH
Last Name:SWARTZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 514
Mailing Address - Street 2:
Mailing Address - City:W. NEWBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01985
Mailing Address - Country:US
Mailing Address - Phone:978-521-5624
Mailing Address - Fax:978-463-4962
Practice Address - Street 1:243 CHARLES ST.
Practice Address - Street 2:SUITE 264 MASSACHUSETTS EYE & EAR INFIRMARY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-3096
Practice Address - Country:US
Practice Address - Phone:978-521-5624
Practice Address - Fax:978-463-4962
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4996103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0520411Medicaid
MA0520411Medicaid