Individual
JEAN B. PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
22 BAYVIEW AVE, STONINGTON, CT 06378-1142
(860) 536-4478
(860) 536-4478
Mailing address
6 GODFREY ST, MYSTIC, CT 06355-1702
(860) 536-4478
(860) 536-4478
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
003735
CT
1041C0700X
Clinical Social Worker
R010111-1
NY
Other
Enumeration date
11/06/2006
Last updated
01/25/2012
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