Provider Demographics
NPI:1104135847
Name:PEFFER, AMY CHRISTINE (LICSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:CHRISTINE
Last Name:PEFFER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 GRAND AVE S
Mailing Address - Street 2:APT. 8
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1154
Mailing Address - Country:US
Mailing Address - Phone:612-298-0322
Mailing Address - Fax:
Practice Address - Street 1:3749 GRAND AVE S
Practice Address - Street 2:APT. 8
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1154
Practice Address - Country:US
Practice Address - Phone:612-298-0322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN175721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical