Provider Demographics
NPI:1790856896
Name:PEFFER, PAUL ROLAND (MSW)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:ROLAND
Last Name:PEFFER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 PALMATUM
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-1862
Mailing Address - Country:US
Mailing Address - Phone:714-321-4564
Mailing Address - Fax:
Practice Address - Street 1:3 PALMATUM
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92620-1862
Practice Address - Country:US
Practice Address - Phone:714-321-4564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health