Provider Demographics
NPI:1942577671
Name:PETERSON, BRUCE D
Entity Type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:D
Last Name:PETERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:BRUCE
Other - Middle Name:D
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:D MIN
Mailing Address - Street 1:558 NEPONSET ST
Mailing Address - Street 2:
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5202
Mailing Address - Country:US
Mailing Address - Phone:617-840-4478
Mailing Address - Fax:781-255-9272
Practice Address - Street 1:558 NEPONSET ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5202
Practice Address - Country:US
Practice Address - Phone:617-840-4478
Practice Address - Fax:781-255-9272
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist