Petersen, Timothy J
Petersen, Timothy J is an sole proprietor health care provider with primary practice located at 1 Bowdoin Sq 7Th Floor, Office 744, Boston MA 02114-2927. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Petersen, Timothy J can be contacted via phone (617) 643-0262.Contact Information
Primary practice address
1 Bowdoin Sq 7Th Floor, Office 744
Boston MA 02114-2927
Phone: (617) 643-0262
Fax: (617) 726-2992
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 7731 | Massachusetts |
Profile Details
| NPI number | 1295737898 |
|---|---|
| LBN Legal business name | Petersen, Timothy J |
| Credentials | PHD |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Aug 12th, 2005 |
| Last updated | Sep 4th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1295737898 | NPPES |
| Massachusetts | MEDICAID | 0503002 |
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