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Organization
REBECCA L. PETERSEN, LCSW, LLC
Active
Organization
REBECCA L. PETERSEN, LCSW, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. REBECCA LEE PETERSEN LCSW (OWNER/PSYCHOTHERAPIST)
(860) 227-6839
Entity
Organization
Contact information
Practice address
147 DURHAM RD, OAK PARK, MADISON, CT 06443-2675
(860) 227-6839
Mailing address
1 VACCINIUM WAY, OLD LYME, CT 06371-2809
(860) 227-6839
(203) 643-2204
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
008697
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008056034
—
CT
Enumeration date
07/30/2015
Last updated
07/30/2015
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