Provider Demographics
NPI:1902977085
Name:PETER, NANCY E (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:E
Last Name:PETER
Suffix:
Gender:F
Credentials:MSW, LCSW
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 263
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-0263
Mailing Address - Country:US
Mailing Address - Phone:847-212-6329
Mailing Address - Fax:847-486-0983
Practice Address - Street 1:3330 OLD GLENVIEW RD
Practice Address - Street 2:SUITE 1
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2963
Practice Address - Country:US
Practice Address - Phone:847-212-6329
Practice Address - Fax:847-486-0983
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490083331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK47593Medicare PIN