Individual
CHARLES PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
185 SILAS DEANE HWY, WETHERSFIELD, CT 06109
(860) 698-1680
Mailing address
1487 LONGMEADOW ST, LONGMEADOW, MA 01106-2204
(413) 726-8716
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
003293
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
115479-8502
—
CT
Enumeration date
09/01/2015
Last updated
09/11/2018
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