Provider Demographics
NPI:1629373766
Name:GERSON, PETER S (MA)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:S
Last Name:GERSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1603
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:VT
Mailing Address - Zip Code:05661-1603
Mailing Address - Country:US
Mailing Address - Phone:802-888-6215
Mailing Address - Fax:802-888-9474
Practice Address - Street 1:111 MAIN ST.
Practice Address - Street 2:GREEN RIVER GUILD
Practice Address - City:HYDE PARK
Practice Address - State:VT
Practice Address - Zip Code:05665
Practice Address - Country:US
Practice Address - Phone:802-888-6215
Practice Address - Fax:802-888-9474
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT047.0071480103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical