Basic Information
| Provider Information | |||||||||
| NPI: | 1174638001 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIOLETTE | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MSW-LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 HATCH DR | ||||||||
| Address2: | PO BOX 1018 | ||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047362161 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074986431 | ||||||||
| FaxNumber: | 2074923181 | ||||||||
| Practice Location | |||||||||
| Address1: | 24 SWEDEN ST | ||||||||
| Address2: | |||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047362127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074933361 | ||||||||
| FaxNumber: | 2074924889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC10632 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.