Provider Demographics
NPI:1821676685
Name:PETERSON, SAMANTHA (LSW)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08876-3005
Mailing Address - Country:US
Mailing Address - Phone:908-707-0212
Mailing Address - Fax:
Practice Address - Street 1:285 E MAIN ST
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-3005
Practice Address - Country:US
Practice Address - Phone:908-707-0212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical