Individual
PROF. JULIE ANN PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
28 WINTER ST, UNIT 2, NORWAY, ME 04268-5620
(207) 890-8779
(207) 739-2423
Mailing address
28 WINTER ST, UNIT 2, NORWAY, ME 04268-5620
(207) 890-8779
(207) 739-2423
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC8164
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
098465
ANTHEM BC BS
ME
01
—
11328070
CAQH
ME
01
—
205225180
TRICARE
ME
05
—
276110000
—
ME
Enumeration date
01/19/2007
Last updated
07/08/2007
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