Provider Demographics
NPI:1861767204
Name:SCHWARTZ, PETER SCOTT (MS)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:SCOTT
Last Name:SCHWARTZ
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 PINE ST
Mailing Address - Street 2:
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06710-2169
Mailing Address - Country:US
Mailing Address - Phone:203-756-7287
Mailing Address - Fax:203-596-2789
Practice Address - Street 1:52 PINE ST
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06710-2169
Practice Address - Country:US
Practice Address - Phone:203-756-7287
Practice Address - Fax:203-596-2789
Is Sole Proprietor?:No
Enumeration Date:2012-03-19
Last Update Date:2012-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional