Provider Demographics
NPI:1144281387
Name:PETERSON, NANET A (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:NANET
Middle Name:A
Last Name:PETERSON
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 1:512 HAYES ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1916
Mailing Address - Country:US
Mailing Address - Phone:610-691-1129
Mailing Address - Fax:610-691-4311
Practice Address - Street 1:1544 W. HAMILTONSTREET
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18102
Practice Address - Country:US
Practice Address - Phone:610-691-1129
Practice Address - Fax:610-691-4311
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-29
Last Update Date:2013-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CW017688101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA225254OtherCOMP PSYCH
PA311747OtherMANAGED HEALTH NET
PA50013538OtherCAPITAL BLUE CROSS
PA50013539OtherAMERICAN HUMAN SERVICES