Most Relevant Information
Provider Data
| NPI Number: | 1003682287 |
| Provider Name: | ELISHAMA PETERSEN |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: |
Most Important Dates
| Enumeration Date: | 11/29/2023 |
| Last Updated: | 11/29/2023 |
Provider Practice Location
614 COOPER HILL RD
WYNANTSKILL
NY
121982906
Practice Location Phone/Fax
| Phone: | 5182836500 |
| Fax: |
Provider Mailing Location
PO BOX 219
WYNANTSKILL
NY
121980219
Provider Mailing Phone/Fax
| Phone: | 5182836500 |
| Fax: |