Provider Demographics
NPI:1881877678
Name:PETERSON, PAULETTE RUTH (LMHC, LMFT)
Entity type:Individual
Prefix:MS
First Name:PAULETTE
Middle Name:RUTH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:MS
Other - First Name:PAULETTE
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 HARRIS STREET
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950
Mailing Address - Country:US
Mailing Address - Phone:617-447-4044
Mailing Address - Fax:
Practice Address - Street 1:8 HARRIS STREET
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950
Practice Address - Country:US
Practice Address - Phone:617-447-4044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-14
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC101Y00000X
MALMFT106H00000X
MALMHC3341101YM0800X
MALMFT819106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health