Provider Demographics
NPI:1306918792
Name:PERSOFF, PETER (LICSW)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:PERSOFF
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 LAKEVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01235-9251
Mailing Address - Country:US
Mailing Address - Phone:413-655-2071
Mailing Address - Fax:413-655-8833
Practice Address - Street 1:251 FENN ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5269
Practice Address - Country:US
Practice Address - Phone:413-496-9671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1117721041C0700X
NYPR012213-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical