Provider Demographics
NPI:1366404279
Name:DUBY, PETER B (LMSW, CSW)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:B
Last Name:DUBY
Suffix:
Gender:M
Credentials:LMSW, CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S WENONA ST
Mailing Address - Street 2:SUITE G29
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-8820
Mailing Address - Country:US
Mailing Address - Phone:989-893-3212
Mailing Address - Fax:989-893-0461
Practice Address - Street 1:2578 MCLEOD DR N
Practice Address - Street 2:UNIT 1
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2858
Practice Address - Country:US
Practice Address - Phone:989-799-5440
Practice Address - Fax:989-799-5651
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010738841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical