Individual
ERIK J PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BCBA
Contact information
Practice address
321 FORTUNE BLVD, MILFORD, MA 01757-1750
(508) 478-0207
(508) 634-6984
Mailing address
30 SANDY BEACH RD, PLYMOUTH, MA 02360-3283
(508) 295-2721
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
042197449
TRICARE
MA
Enumeration date
06/16/2010
Last updated
08/10/2012
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