Basic Information
| Provider Information | |||||||||
| NPI: | 1700254976 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PETERSON | ||||||||
| FirstName: | TASHA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 WEST STREET | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | HOMESTEAD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124010870 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1800 WEST STREET | ||||||||
| Address2: | 4TH FLOOR | ||||||||
| City: | HOMESTEAD | ||||||||
| State: | PA | ||||||||
| PostalCode: | 15120 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124644781 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2015 | ||||||||
| LastUpdateDate: | 09/04/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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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.