Provider Demographics
NPI:1023679016
Name:PETERS, ALLISON ROSE
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:ROSE
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:319 W LANDIS AVE
Mailing Address - Street 2:
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08360-8101
Mailing Address - Country:US
Mailing Address - Phone:856-457-5814
Mailing Address - Fax:856-457-5816
Practice Address - Street 1:319 W LANDIS AVE
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-8101
Practice Address - Country:US
Practice Address - Phone:856-457-5814
Practice Address - Fax:856-457-5816
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00472100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health