Provider Demographics
NPI:1902340516
Name:HAFFORD, PETER JOHN (LLMSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:JOHN
Last Name:HAFFORD
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48708-8103
Mailing Address - Country:US
Mailing Address - Phone:989-894-2851
Mailing Address - Fax:989-894-4522
Practice Address - Street 1:1400 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48708-8103
Practice Address - Country:US
Practice Address - Phone:989-894-2851
Practice Address - Fax:989-894-4522
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011005161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical