Provider Demographics
NPI:1245338524
Name:STIMPSON, PETER K (MSW, MTH)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:K
Last Name:STIMPSON
Suffix:
Gender:M
Credentials:MSW, MTH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 STOCKTON ST
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6813
Mailing Address - Country:US
Mailing Address - Phone:609-924-0060
Mailing Address - Fax:609-924-7436
Practice Address - Street 1:22 STOCKTON ST
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-6813
Practice Address - Country:US
Practice Address - Phone:609-924-0060
Practice Address - Fax:609-924-7436
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC001794001041C0700X
NYPR020016-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ761435BN3Medicare ID - Type Unspecified