Provider Demographics
NPI:1912195926
Name:HANTZIS, PETER (EDD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:HANTZIS
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170B CONCORD ROAD
Mailing Address - Street 2:
Mailing Address - City:CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01824-4645
Mailing Address - Country:US
Mailing Address - Phone:978-250-3332
Mailing Address - Fax:
Practice Address - Street 1:170B CONCORD ROAD
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-4645
Practice Address - Country:US
Practice Address - Phone:978-250-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7049103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist