Organization
PM VIETZE PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER VIETZE PHD (PRESIDENT)
(347) 668-4992
Entity
Organization
Contact information
Practice address
957 CEDARBROOK ROAD, PLAINFIELD, NJ 07060-2646
(347) 668-4992
(908) 757-8322
Mailing address
957 CEDARBROOK ROAD, PLAINFIELD, NJ 07060-2646
(347) 668-4992
(908) 757-8322
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0625558
—
NJ
Enumeration date
07/30/2020
Last updated
07/30/2020
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