Individual
MR. NATHAN Y PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
L.M.H.C.
Contact information
Practice address
172 LINCOLN ST, WORCESTER, MA 01605-3750
(508) 770-0511
(508) 770-0875
Mailing address
59 WHITINS RD, SUTTON, MA 01590-2728
(508) 770-0511
(508) 770-0875
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
4378
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
MA4378
BCBSMA
MA
Enumeration date
11/28/2006
Last updated
07/08/2007
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