Individual
KISHMAR PETERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
589 SOUTH CT, DAYTONA BEACH, FL 32114-6009
(386) 868-1992
Mailing address
589 SOUTH CT, DAYTONA BEACH, FL 32114-6009
(386) 868-1992
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
FL
Other
Enumeration date
07/13/2016
Last updated
07/13/2016
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