Provider Demographics
NPI:1659124741
Name:PETERMAN, JERRAD
Entity Type:Individual
Prefix:MR
First Name:JERRAD
Middle Name:
Last Name:PETERMAN
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 1:6 BROOK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:HARRISON CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15636-1312
Mailing Address - Country:US
Mailing Address - Phone:724-833-3247
Mailing Address - Fax:
Practice Address - Street 1:8700 PENNSYLVANIA AVE STE 3
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2715
Practice Address - Country:US
Practice Address - Phone:724-863-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health