Provider Demographics
NPI:1215339254
Name:PETSOS, MARIA
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:PETSOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BAGGALEY RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08690-1814
Mailing Address - Country:US
Mailing Address - Phone:609-847-0951
Mailing Address - Fax:
Practice Address - Street 1:6 BAGGALEY RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:NJ
Practice Address - Zip Code:08690-1814
Practice Address - Country:US
Practice Address - Phone:609-847-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-13-13382103K00000X
NJ1-13-13382103K00000X
PA1-13-13382103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst