Provider Demographics
NPI:1992011910
Name:LI, PEIWEI (PHD, HSP)
Entity Type:Individual
Prefix:DR
First Name:PEIWEI
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:PHD, HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 GARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1711
Mailing Address - Country:US
Mailing Address - Phone:413-391-4167
Mailing Address - Fax:
Practice Address - Street 1:40 GARRISON AVE
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-1711
Practice Address - Country:US
Practice Address - Phone:413-391-4167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-27
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11102103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Single Specialty