Organization
POLLY W. PETERSON, PH.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. POLLY WIETZKE PETERSON PHD (PSYCHOLOGIST/OWNER)
(904) 742-8164
Entity
Organization
Contact information
Practice address
1543 KINGSLEY AVE STE 14, ORANGE PARK, FL 32073-4570
(904) 742-8235
(904) 217-7222
Mailing address
2465 US HIGHWAY 1 S UNIT 154, SAINT AUGUSTINE, FL 32086-6076
(904) 742-8164
(904) 217-7222
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
02/11/2022
Last updated
02/11/2022
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