Provider Demographics
NPI:1396952818
Name:GUTHRIE, PETER (LICSW)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:GUTHRIE
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 1:50 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:MA
Mailing Address - Zip Code:02478-3171
Mailing Address - Country:US
Mailing Address - Phone:617-489-8910
Mailing Address - Fax:
Practice Address - Street 1:5 WATSON RD
Practice Address - Street 2:#203
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-3924
Practice Address - Country:US
Practice Address - Phone:617-489-8910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10265711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO73629OtherBLUECROSSBLUE SHIELD MA
MA7979569OtherAETNA
PO73629OtherBLUECROSSBLUE SHIELD MA