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Stephanie Elizabeth Petersen

NPI Registration Record

Provider / OrganizationNPIDate Certified
STEPHANIE ELIZABETH PETERSEN14872697592020-09-13
Entity TypeIndividual
Provider Name Stephanie Elizabeth Petersen L.M.S.W.
Practice Office Address153 SALZBURG VLG
PALMYRA, NY US
Practice Office Telephone3155693053
Mailing Address153 SALZBURG VLG
PALMYRA, NY 145221343 US
Business Telephone3155693053
HPT Codes
CodeLicense NoState
104100000X PRIMARY104529 NY
193400000X SINGGroup Code
OPI Codes

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