Provider Demographics
NPI:1952465593
Name:HERBST, PETER (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:HERBST
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:880 BERGEN AVE
Mailing Address - Street 2:ROOM 302
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07306-4305
Mailing Address - Country:US
Mailing Address - Phone:201-798-5588
Mailing Address - Fax:201-798-4242
Practice Address - Street 1:880 BERGEN AVE
Practice Address - Street 2:ROOM 302
Practice Address - City:JERSEY CITY
Practice Address - State:NJ
Practice Address - Zip Code:07306-4305
Practice Address - Country:US
Practice Address - Phone:201-798-5588
Practice Address - Fax:201-798-4242
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC051614001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical