Individual
MR. GORDON WAYNE PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MSW, LICSW
Contact information
Practice address
166 BATTERY ST, BURLINGTON, VT 05401-5283
(802) 862-3373
Mailing address
763 NORTH AVE, BURLINGTON, VT 05401-2728
(802) 862-9067
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
089-0000142
VT
Other
Enumeration date
09/29/2006
Last updated
07/08/2007
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