Provider Demographics
NPI:1871528034
Name:BISHOP, PETER DARROW (PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:DARROW
Last Name:BISHOP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 GRANBY RD
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01020-1568
Mailing Address - Country:US
Mailing Address - Phone:413-523-0900
Mailing Address - Fax:413-523-0901
Practice Address - Street 1:1109 GRANBY RD
Practice Address - Street 2:
Practice Address - City:CHICOPEE
Practice Address - State:MA
Practice Address - Zip Code:01020-1568
Practice Address - Country:US
Practice Address - Phone:413-523-0900
Practice Address - Fax:413-523-0901
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8146103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1202057Medicaid
MA1202057Medicaid