Provider Demographics
NPI:1649309857
Name:PETERSON, LORETTA DOLORES (MSW)
Entity type:Individual
Prefix:MRS
First Name:LORETTA
Middle Name:DOLORES
Last Name:PETERSON
Suffix:
Gender:
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3526 TERRACE DR APT B
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2841
Mailing Address - Country:US
Mailing Address - Phone:202-450-7563
Mailing Address - Fax:
Practice Address - Street 1:3526 TERRACE DR APT B
Practice Address - Street 2:
Practice Address - City:SUITLAND
Practice Address - State:MD
Practice Address - Zip Code:20746-2841
Practice Address - Country:US
Practice Address - Phone:202-450-7563
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3008071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical