Provider Demographics
NPI:1457622425
Name:PETERS, MARGARET SMITH
Entity Type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:SMITH
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:MARY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:221 CHENANGO BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13901-1293
Mailing Address - Country:US
Mailing Address - Phone:607-762-6978
Mailing Address - Fax:607-762-6979
Practice Address - Street 1:221 CHENANGO BRIDGE
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13901
Practice Address - Country:US
Practice Address - Phone:607-762-6978
Practice Address - Fax:607-763-6979
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2012-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO27479-11041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool