# PM VIETZE PHD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548879984
- **Authorized official:** DR. PETER VIETZE PHD (PRESIDENT)
- **Authorized official phone:** (347) 668-4992

## Contact information

- **Practice address:** 957 CEDARBROOK ROAD, PLAINFIELD, NJ 07060-2646
- **Practice address phone:** (347) 668-4992
- **Practice address fax:** (908) 757-8322
- **Mailing address:** 957 CEDARBROOK ROAD, PLAINFIELD, NJ 07060-2646
- **Mailing address phone:** (347) 668-4992
- **Mailing address fax:** (908) 757-8322

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | NULL | Yes |
| 103TC2200X | Clinical Child & Adolescent Psychologist | — | — | Yes |

## Other

- **Enumeration date:** 07/30/2020
- **Last updated:** 07/30/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0625558 | — | NJ |