| Polly W. Peterson, Ph.d. | |
|
1543 Kingsley Ave Ste 14 Orange Park FL 32073-4570 | |
| (904) 742-8235 | |
| (904) 217-7222 |
| Full Name | Polly W. Peterson, Ph.d. |
|---|---|
| Speciality | Psychologist |
| Location | 1543 Kingsley Ave Ste 14, Orange Park, Florida |
| Authorized Official Name and Position | Polly Wietzke Peterson (PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 9047428164 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Polly W. Peterson, Ph.d. 2465 Us Highway 1 S Unit 154 Saint Augustine FL 32086-6076 Ph: (904) 742-8164 | Polly W. Peterson, Ph.d. 1543 Kingsley Ave Ste 14 Orange Park FL 32073-4570 Ph: (904) 742-8235 |
| NPI Number | 1427702091 |
|---|---|
| Provider Enumeration Date | 02/11/2022 |
| Last Update Date | 02/11/2022 |
| Certification Date | 02/11/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427702091 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | (* (Not Available)) | Primary |
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