| Laura Petersen, M.s.w., L.c.s.w., L.l.c. | |
|
901 S Rogers St Suite 202 Bloomington IN 47403-4756 | |
| (812) 369-7683 | |
| Not Available |
| Full Name | Laura Petersen, M.s.w., L.c.s.w., L.l.c. |
|---|---|
| Speciality | Social Worker |
| Location | 901 S Rogers St, Bloomington, Indiana |
| Authorized Official Name and Position | Laura Christine Petersen (OWNER/THERAPIST) |
| Authorized Official Contact | 8123697683 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Laura Petersen, M.s.w., L.c.s.w., L.l.c. 901 S Rogers St Suite 202 Bloomington IN 47403-4756 Ph: (812) 369-7683 | Laura Petersen, M.s.w., L.c.s.w., L.l.c. 901 S Rogers St Suite 202 Bloomington IN 47403-4756 Ph: (812) 369-7683 |
| NPI Number | 1063652238 |
|---|---|
| Provider Enumeration Date | 03/02/2009 |
| Last Update Date | 06/08/2015 |
| Medicare PECOS PAC ID | 9830401033 |
|---|---|
| Medicare Enrollment ID | O20150630002749 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063652238 | NPI | - | NPPES |
| 200887530A | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 34004770A (Indiana) | Primary |
| Provider Name | Laura C Petersen |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1548203045 PECOS PAC ID: 6204806060 Enrollment ID: I20040728001617 |
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