Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 103G00000X | Clinical Psychologist | 9179 | MA |
Y | 103TC0700X | Clinical Psychologist | 9179 | MA |
NPI | 1013133503 |
---|---|
Provider Name | Eric J. Peters |
First Address | Lenox, MA 01240-2519 |
Second Address | Lenox, MA 01240-2519 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 11/06/2019 |