Individual
TIMOTHY J PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1 BOWDOIN SQ, 7TH FLOOR, OFFICE 744, BOSTON, MA 02114-2927
(617) 643-0262
(617) 726-2992
Mailing address
1 BOWDOIN SQ, 7TH FLOOR, OFFICE 744, BOSTON, MA 02114-2927
(617) 643-0262
(617) 726-2992
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
7731
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0503002
—
MA
Enumeration date
08/12/2005
Last updated
09/04/2008
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