Provider Demographics
NPI:1821110594
Name:PETERSON, BARNES (LCMHC)
Entity Type:Individual
Prefix:
First Name:BARNES
Middle Name:
Last Name:PETERSON
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 MYRTLE ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-4354
Mailing Address - Country:US
Mailing Address - Phone:603-668-0014
Mailing Address - Fax:603-623-7676
Practice Address - Street 1:161 MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431-3772
Practice Address - Country:US
Practice Address - Phone:603-357-3093
Practice Address - Fax:603-357-7810
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH128101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1041623OtherCIGNA
NH5396216OtherUBH PACIFICARE
NH14Y000949NH01OtherWELLPOINT BHN
NH30420622Medicaid
VT1011130OtherVT MEDICAID
NH11718745OtherCAQH