Basic Information
| Provider Information | |||||||||
| NPI: | 1073719985 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERS | ||||||||
| FirstName: | ELIAZBETH | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | LSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 952 N NEGLEY AVE | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152061591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4122604474 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6324 MARCHAND ST | ||||||||
| Address2: | |||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152064312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4126611239 | ||||||||
| FaxNumber: | 4126611304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.