Provider Demographics
NPI:1750494506
Name:PETERS, JOAN CAROL (MSW)
Entity Type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:CAROL
Last Name:PETERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 S. PALM AVE.
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236
Mailing Address - Country:US
Mailing Address - Phone:941-952-5200
Mailing Address - Fax:
Practice Address - Street 1:73 S PALM AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5638
Practice Address - Country:US
Practice Address - Phone:941-952-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00043361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7351Medicare ID - Type Unspecified