Provider Demographics
NPI:1588490544
Name:PETERMAN, ROBERT (LAC)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PETERMAN
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 SHEPPARD RD
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4797
Mailing Address - Country:US
Mailing Address - Phone:609-310-1852
Mailing Address - Fax:
Practice Address - Street 1:1103 SHEPPARD RD
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-4797
Practice Address - Country:US
Practice Address - Phone:609-310-1852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-09
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00815400101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health