Provider Demographics
NPI:1972126415
Name:XAVIER, PETA (MS, LBS)
Entity type:Individual
Prefix:
First Name:PETA
Middle Name:
Last Name:XAVIER
Suffix:
Gender:F
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 5TH AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4232
Mailing Address - Country:US
Mailing Address - Phone:717-263-9555
Mailing Address - Fax:717-709-6529
Practice Address - Street 1:125 SCHNEIDER DR
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17046-4875
Practice Address - Country:US
Practice Address - Phone:717-270-2444
Practice Address - Fax:717-270-2472
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH001357174400000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PABH001357OtherSTATE LICENSE
14917473OtherCAQH