Provider Demographics
NPI:1053692962
Name:PETERS, DAVID JR
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:PETERS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:
Other - Last Name:PETERS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:112 CHAUNCEY AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-2516
Mailing Address - Country:US
Mailing Address - Phone:914-633-3855
Mailing Address - Fax:
Practice Address - Street 1:112 CHAUNCEY AVE
Practice Address - Street 2:
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-2516
Practice Address - Country:US
Practice Address - Phone:914-633-3855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084155-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker