Gordon Wayne Petersen in Burlington - Clinical
Gordon Wayne Petersen - NPI 1487746244
Gordon Wayne Petersen is a Clinical in Burlington, Vermont. Gordon Wayne Petersen practices all healthcare services and medical treatments related to Clinical. The NPI Number for Gordon Wayne Petersen is 1487746244. The last update date is 2007-07-08.
Gordon Wayne Petersen's current location address is 763 North Ave, Burlington, Vermont. You can contact this provider via phone number 8028629067. The mailing address for Gordon Wayne Petersen is 763 North Ave, Burlington, Vermont. To know further, please read the information below!
Provider Profile Detail
Provider Name | Gordon Wayne Petersen |
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Address | 763 North Ave, Burlington, Vermont |
Phone Number | 8028629067 |
Fax Number | |
Sole Proprietor | Y |
Credentials | MSW, LICSW |
NPI Number Detail
NPI Number | 1487746244 |
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Provider Enumeration Date | 2006-09-29 |
Last Updated Date | 2007-07-08 |
Provider Mailing Address Detail
Address | 763 North Ave |
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City | Burlington |
State | Vermont (VT) |
Post Code | 54012728 |
Phone Number | 8028629067 |
Fax Number |
Provider's Primary Taxonomy Detail
Speciality | Clinical |
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Taxonomy | 1041C0700X |
Licence No | 089-0000142 |
Definition: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certif |
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What is the unique identification code assigned to Gordon Wayne Petersen by the Centers for Medicare & Medicaid Services?
The Gordon Wayne Petersen has been issued the NPI (National Provider Identifier) 1487746244. This 10-digit code serves as a unique identifier for healthcare providers, assigned by the Centers for Medicare & Medicaid Services (CMS).
Could you please provide the complete street address where Gordon Wayne Petersen is physically located?
The Gordon Wayne Petersen is physically situated at the following address: 763 North Ave, Burlington, VT, 54012728.
What is Gordon Wayne Petersen's area of specialization, and what is the corresponding taxonomy classification code for this field of practice?
The specialized area of practice for Gordon Wayne Petersen is Clinical, and the taxonomy code that categorizes this field of expertise is 1041C0700X.
On what date did the Gordon Wayne Petersen receive its 1487746244 assignment from the Centers for Medicare & Medicaid Services?
The Gordon Wayne Petersen was assigned its 1487746244 by the Centers for Medicare & Medicaid Services on 2006-09-29.
As of what date were the details related to Gordon Wayne Petersen most recently updated or revised?
The information pertaining to Gordon Wayne Petersen, including its address, specialty, and other relevant details, was last updated or revised on 2007-07-08.