Provider Demographics
NPI:1215524103
Name:PETERSON, AMELIA REEVES (LMHC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:REEVES
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:
Other - Last Name:TRAINOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:184 N RIVER RD
Mailing Address - Street 2:
Mailing Address - City:FORT EDWARD
Mailing Address - State:NY
Mailing Address - Zip Code:12828-2902
Mailing Address - Country:US
Mailing Address - Phone:518-817-6430
Mailing Address - Fax:
Practice Address - Street 1:184 N RIVER RD
Practice Address - Street 2:
Practice Address - City:FORT EDWARD
Practice Address - State:NY
Practice Address - Zip Code:12828-2902
Practice Address - Country:US
Practice Address - Phone:978-712-8661
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-25
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010081101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty