Organization
LAURA PETERSEN, M.S.W., L.C.S.W., L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LAURA CHRISTINE PETERSEN M.S.W., L.C.S.W. (OWNER/THERAPIST)
(812) 369-7683
Entity
Organization
Contact information
Practice address
901 S ROGERS ST, SUITE 202, BLOOMINGTON, IN 47403-4756
(812) 369-7683
Mailing address
901 S ROGERS ST, SUITE 202, BLOOMINGTON, IN 47403-4756
(812) 369-7683
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
34004770A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200887530A
—
IN
Enumeration date
03/02/2009
Last updated
06/08/2015
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