Provider Demographics
NPI:1780395590
Name:OLIVER, PETER VANNAH (PHD, LPC, MA, NCC)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:VANNAH
Last Name:OLIVER
Suffix:
Gender:M
Credentials:PHD, LPC, MA, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 WICKHAM RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2552
Mailing Address - Country:US
Mailing Address - Phone:860-778-1551
Mailing Address - Fax:
Practice Address - Street 1:200 WICKHAM RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-2552
Practice Address - Country:US
Practice Address - Phone:860-778-1551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001269101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health