Provider Demographics
NPI:1699831370
Name:PETERS, KARL JOHN (MSW LICSW)
Entity Type:Individual
Prefix:MR
First Name:KARL
Middle Name:JOHN
Last Name:PETERS
Suffix:
Gender:M
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 CENTRAL ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3703
Mailing Address - Country:US
Mailing Address - Phone:978-749-8944
Mailing Address - Fax:
Practice Address - Street 1:21 CENTRAL ST
Practice Address - Street 2:SUITE 6
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3703
Practice Address - Country:US
Practice Address - Phone:978-749-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04383Medicare ID - Type Unspecified