Provider Demographics
NPI:1972904332
Name:PETERSEN, AARON (MSW)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-1564
Mailing Address - Country:US
Mailing Address - Phone:847-412-4385
Mailing Address - Fax:847-412-4360
Practice Address - Street 1:255 REVERE DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-1564
Practice Address - Country:US
Practice Address - Phone:847-412-4385
Practice Address - Fax:847-412-4360
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker