Provider Demographics
NPI:1821769597
Name:MICHAELS, PETER LEONARD (MA, CAGS)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:LEONARD
Last Name:MICHAELS
Suffix:
Gender:M
Credentials:MA, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 LEDGE ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060-3073
Mailing Address - Country:US
Mailing Address - Phone:603-966-1000
Mailing Address - Fax:
Practice Address - Street 1:10 MANCHESTER ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2107
Practice Address - Country:US
Practice Address - Phone:603-966-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH51056103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool