Provider Demographics
NPI:1720134752
Name:TAYLOR, PETER JOHN (LICSW)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:JOHN
Last Name:TAYLOR
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 1:15 OLESEN RD
Mailing Address - Street 2:
Mailing Address - City:DERRY
Mailing Address - State:NH
Mailing Address - Zip Code:03038-4847
Mailing Address - Country:US
Mailing Address - Phone:603-437-1522
Mailing Address - Fax:
Practice Address - Street 1:1228 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1349
Practice Address - Country:US
Practice Address - Phone:603-668-4111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH3281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical