Provider Demographics
NPI:1285176545
Name:PETERS, KIMBERLY G (LSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:PETERS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S EDWIN C MOSES BLVD
Mailing Address - Street 2:FOURTH FLOOR, SAMARITAN BEHAVIORAL HEALTH, INC
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-3424
Mailing Address - Country:US
Mailing Address - Phone:937-734-8333
Mailing Address - Fax:937-734-8269
Practice Address - Street 1:601 S EDWIN C MOSES BLVD
Practice Address - Street 2:FOURTH FLOOR, SAMARITAN BEHAVIORAL HEALTH, INC.
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-3424
Practice Address - Country:US
Practice Address - Phone:937-734-8333
Practice Address - Fax:937-734-8269
Is Sole Proprietor?:No
Enumeration Date:2016-11-17
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.0027078104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker