Individual
MR. JAMES RANDALL PETERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
1202 STATE ST, ERIE, PA 16501-1914
(814) 454-4530
(814) 456-2375
Mailing address
PO BOX 369, ERIE, PA 16512-0369
(814) 454-4530
(814) 456-2375
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
CW014391
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
018917920001
—
PA
01
—
023539
VMC BEHAVIORAL HEALTH CAR
—
01
—
104836
MAGELLAN
PA
01
—
472500
VALUE OPTIONS
—
01
—
910493
HIGHMARK BCBS
PA
Enumeration date
02/21/2007
Last updated
09/13/2013
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