Provider Demographics
NPI:1194875757
Name:PARSONS, PETER WAYNE (MSW/LICSW)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:WAYNE
Last Name:PARSONS
Suffix:
Gender:M
Credentials:MSW/LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 WASHINGTON ST APT 4
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3550
Mailing Address - Country:US
Mailing Address - Phone:978-879-4455
Mailing Address - Fax:
Practice Address - Street 1:37 WASHINGTON ST APT 4
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-3550
Practice Address - Country:US
Practice Address - Phone:978-879-4455
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10242371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07041Medicare ID - Type UnspecifiedPROVIDER NUMBER