Provider Demographics
NPI:1386691731
Name:CASGRAIN, PETER B (PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:B
Last Name:CASGRAIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3872 E HARBOR LIGHT LANDING DR
Mailing Address - Street 2:
Mailing Address - City:PORT CLINTON
Mailing Address - State:OH
Mailing Address - Zip Code:43452-3877
Mailing Address - Country:US
Mailing Address - Phone:419-734-3333
Mailing Address - Fax:419-734-3335
Practice Address - Street 1:3872 E HARBOR LIGHT LANDING DR
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-3877
Practice Address - Country:US
Practice Address - Phone:419-734-3333
Practice Address - Fax:419-734-3335
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4256103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCP04173Medicare ID - Type Unspecified