Provider Demographics
NPI:1689005365
Name:SWENSON, PETER
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:SWENSON
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:PO BOX 3369
Mailing Address - Street 2:
Mailing Address - City:NANTUCKET
Mailing Address - State:MA
Mailing Address - Zip Code:02584-3369
Mailing Address - Country:US
Mailing Address - Phone:508-228-2689
Mailing Address - Fax:
Practice Address - Street 1:20 VESPER LN
Practice Address - Street 2:
Practice Address - City:NANTUCKET
Practice Address - State:MA
Practice Address - Zip Code:02554-4394
Practice Address - Country:US
Practice Address - Phone:508-228-2689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-06
Last Update Date:2013-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst