Provider Demographics
NPI:1144327560
Name:PETERSON, ELIZABETH (MSW,LCSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:
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 1:3571 SANCTUARY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769
Mailing Address - Country:US
Mailing Address - Phone:407-498-3056
Mailing Address - Fax:407-846-5225
Practice Address - Street 1:2647 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-1936
Practice Address - Country:US
Practice Address - Phone:407-846-5220
Practice Address - Fax:407-846-5225
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW82811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical