Provider Demographics
NPI:1891918066
Name:PETERSON, CATHERINE D (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:D
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 NE 5TH AVE
Mailing Address - Street 2:APT 1113
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33137-4053
Mailing Address - Country:US
Mailing Address - Phone:305-444-4566
Mailing Address - Fax:305-444-4577
Practice Address - Street 1:3301 NE 5TH AVE
Practice Address - Street 2:APT 1113
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33137-4053
Practice Address - Country:US
Practice Address - Phone:305-444-4566
Practice Address - Fax:305-444-4577
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0074104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker