Provider Demographics
NPI:1891772141
Name:STARVAGGI, PETER M (LMHC LMFT)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:STARVAGGI
Suffix:
Gender:M
Credentials:LMHC LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02347-1114
Mailing Address - Country:US
Mailing Address - Phone:508-523-3001
Mailing Address - Fax:
Practice Address - Street 1:106 SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5951
Practice Address - Country:US
Practice Address - Phone:508-523-3001
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2057 (LMHC)101YM0800X
MA916 (LMFT)106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM0353OtherBCBS