Provider Demographics
NPI:1154573640
Name:PETERS, ELIZABETH SUSAN (MA)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:SUSAN
Last Name:PETERS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:SUSAN
Other - Last Name:ENGSTROM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:120 CHESNUT STREET
Mailing Address - Street 2:
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450
Mailing Address - Country:US
Mailing Address - Phone:201-444-3550
Mailing Address - Fax:201-652-1613
Practice Address - Street 1:120 CHESNUT STREET
Practice Address - Street 2:
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450
Practice Address - Country:US
Practice Address - Phone:201-444-3550
Practice Address - Fax:201-652-1613
Is Sole Proprietor?:No
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical