Provider Demographics
NPI:1396262945
Name:PETERS, LEEANN (LCSW, LCAS)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:LCSW, LCAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 BISHOP DR
Mailing Address - Street 2:
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-8826
Mailing Address - Country:US
Mailing Address - Phone:518-424-3771
Mailing Address - Fax:
Practice Address - Street 1:190 FOX HOLLOW RD
Practice Address - Street 2:
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-3640
Practice Address - Country:US
Practice Address - Phone:845-876-5400
Practice Address - Fax:845-876-5824
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCLCAS22941101YA0400X
NCC0126061041C0700X
NY094211104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical