Provider Demographics
NPI:1629082714
Name:PETERS, ROBERT JAMES (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:PETERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 UNION ST
Mailing Address - Street 2:
Mailing Address - City:SCHENECTADY
Mailing Address - State:NY
Mailing Address - Zip Code:12308-3104
Mailing Address - Country:US
Mailing Address - Phone:518-372-5667
Mailing Address - Fax:518-372-5686
Practice Address - Street 1:818 UNION ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12308-3104
Practice Address - Country:US
Practice Address - Phone:518-372-5667
Practice Address - Fax:518-372-5686
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR028812-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01938807Medicaid
NY01938807Medicaid