Provider Demographics
NPI:1699087056
Name:DUNFORD, PETER JAMES (LSW)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:JAMES
Last Name:DUNFORD
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 JEFFERSON AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18510-1630
Mailing Address - Country:US
Mailing Address - Phone:570-344-1186
Mailing Address - Fax:570-344-7641
Practice Address - Street 1:615 JEFFERSON AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18510-1630
Practice Address - Country:US
Practice Address - Phone:570-344-1186
Practice Address - Fax:570-344-7641
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW011129L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical