Provider Demographics
NPI:1669718656
Name:PETERSON, ASHLEY ELIZABETH
Entity type:Individual
Prefix:MISS
First Name:ASHLEY
Middle Name:ELIZABETH
Last Name:PETERSON
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 1:548 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01603-2537
Mailing Address - Country:US
Mailing Address - Phone:774-823-1500
Mailing Address - Fax:774-823-1481
Practice Address - Street 1:548 PARK AVE
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01603-2537
Practice Address - Country:US
Practice Address - Phone:774-823-1500
Practice Address - Fax:774-823-1481
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst