Provider Demographics
NPI:1245686179
Name:PETERSON, MARIAH (MS)
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:JO
Other - Last Name:WHITEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:130 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:KEYSER
Mailing Address - State:WV
Mailing Address - Zip Code:26726-3520
Mailing Address - Country:US
Mailing Address - Phone:304-788-1113
Mailing Address - Fax:304-788-2777
Practice Address - Street 1:130 CENTER ST
Practice Address - Street 2:
Practice Address - City:KEYSER
Practice Address - State:WV
Practice Address - Zip Code:26726-3520
Practice Address - Country:US
Practice Address - Phone:304-788-1113
Practice Address - Fax:304-788-2777
Is Sole Proprietor?:No
Enumeration Date:2016-05-10
Last Update Date:2016-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist