Leland W Petersen, CP

NPI #1790902229 in Glen Head, New York

Provider Information

NPI Number: 1790902229
Entity Type: Individual
Name: Leland W Petersen, CP
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Psychologist - Clinical
Credential: CP
Enumeration Date: Apr 19, 2007
Last Updated: Oct 31, 2007

Practice Location

Address: 11 BEECHWOOD DR
City: Glen Head
State: New York
ZIP Code: 11545-1101
Phone: (516) 671-7509

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary

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