| Rebecca L. Petersen, Lcsw, Llc | |
|
147 Durham Rd Oak Park Madison CT 06443-2675 | |
| (860) 227-6839 | |
| Not Available |
| Full Name | Rebecca L. Petersen, Lcsw, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 147 Durham Rd, Madison, Connecticut |
| Authorized Official Name and Position | Rebecca Lee Petersen (OWNER/PSYCHOTHERAPIST) |
| Authorized Official Contact | 8602276839 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Rebecca L. Petersen, Lcsw, Llc 1 Vaccinium Way Old Lyme CT 06371-2809 Ph: (860) 227-6839 | Rebecca L. Petersen, Lcsw, Llc 147 Durham Rd Oak Park Madison CT 06443-2675 Ph: (860) 227-6839 |
| NPI Number | 1437535580 |
|---|---|
| Provider Enumeration Date | 07/30/2015 |
| Last Update Date | 07/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437535580 | NPI | - | NPPES |
| 008056034 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 008697 (Connecticut) | Primary |
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