Provider Demographics
NPI:1629761416
Name:PETERS, JONATHAN A
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:A
Last Name:PETERS
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 1:22 ROYAL CREST DR APT 9
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6466
Mailing Address - Country:US
Mailing Address - Phone:413-888-7255
Mailing Address - Fax:
Practice Address - Street 1:59 LOWES WAY
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-5018
Practice Address - Country:US
Practice Address - Phone:978-690-3923
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral