Provider Demographics
NPI:1134881345
Name:PETER, LAURIE
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:PETER
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 1:40 SHALEBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07960-6638
Mailing Address - Country:US
Mailing Address - Phone:908-500-8438
Mailing Address - Fax:973-425-0824
Practice Address - Street 1:40 SHALEBROOK DR
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-6638
Practice Address - Country:US
Practice Address - Phone:908-500-8438
Practice Address - Fax:973-425-0824
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NJ44SC055162001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical