Provider Demographics
NPI:1679678650
Name:PETERSSON, MARGARET M (PHD LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:M
Last Name:PETERSSON
Suffix:
Gender:F
Credentials:PHD LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3656
Mailing Address - Country:US
Mailing Address - Phone:860-344-8359
Mailing Address - Fax:
Practice Address - Street 1:11 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3656
Practice Address - Country:US
Practice Address - Phone:860-344-8359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0001301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP367367OtherOXFORD
CT134174OtherVALUE OPTIONS
140000130CT01OtherANTHEM
CT4459853OtherAETNA
CT6210733OtherUNITED HEALTH
CT1190372OtherCIGNA
CT212494OtherMHN