Provider Demographics
NPI:1831511716
Name:PETERSON, JO ANN (MED, BCBA)
Entity type:Individual
Prefix:MS
First Name:JO ANN
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 RIVERBANK TER
Mailing Address - Street 2:
Mailing Address - City:TOWNSEND
Mailing Address - State:MA
Mailing Address - Zip Code:01469-1232
Mailing Address - Country:US
Mailing Address - Phone:978-353-3480
Mailing Address - Fax:
Practice Address - Street 1:270 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:MA
Practice Address - Zip Code:01420-8114
Practice Address - Country:US
Practice Address - Phone:978-353-3480
Practice Address - Fax:978-353-3486
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst