Provider Demographics
NPI:1730842519
Name:ABBY PETERFESO LLC
Entity type:Organization
Organization Name:ABBY PETERFESO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ABBY
Authorized Official - Middle Name:L
Authorized Official - Last Name:PETERFESO
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPCC LPC
Authorized Official - Phone:612-842-1515
Mailing Address - Street 1:5775 WAYZATA BLVD SUITE 700 - 4029
Mailing Address - Street 2:
Mailing Address - City:ST. LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416
Mailing Address - Country:US
Mailing Address - Phone:612-842-1515
Mailing Address - Fax:612-457-1547
Practice Address - Street 1:750 2ND ST NE STE 218
Practice Address - Street 2:
Practice Address - City:HOPKINS
Practice Address - State:MN
Practice Address - Zip Code:55343-8124
Practice Address - Country:US
Practice Address - Phone:612-842-1515
Practice Address - Fax:612-842-1515
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-18
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health