Provider Demographics
NPI:1962847905
Name:PETERSON, ALEXANDRA R (MA)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:R
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:236 SOUTH ST
Mailing Address - Street 2:APT 2 R
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-4176
Mailing Address - Country:US
Mailing Address - Phone:617-447-4046
Mailing Address - Fax:
Practice Address - Street 1:236 SOUTH ST
Practice Address - Street 2:APT 2 R
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-4176
Practice Address - Country:US
Practice Address - Phone:617-447-4046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health