Provider Demographics
NPI:1912646241
Name:PEETS, SETH JOSHUA (MA, CAGS)
Entity Type:Individual
Prefix:MR
First Name:SETH
Middle Name:JOSHUA
Last Name:PEETS
Suffix:
Gender:M
Credentials:MA, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05773-9800
Mailing Address - Country:US
Mailing Address - Phone:802-446-3577
Mailing Address - Fax:802-446-3801
Practice Address - Street 1:167 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:VT
Practice Address - Zip Code:05773-9800
Practice Address - Country:US
Practice Address - Phone:802-446-3577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT843956900Medicaid