Active NPI
Peter Vannah Oliver, PH.D., LPC, M.A, NCC
- Professional Counselor
- Glastonbury, CT
National Provider Identifier
1780395590
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 001269
- Practice address
- 200 Wickham Rd
Glastonbury, CT 06033-2552 - Phone
- (860) 778-1551
- NPI assigned
- Dec 13, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 001269 | CT | |
| Professional Counselor | 101YP2500X | 001269 | CT | Primary |
Addresses
Primary practice location
200 Wickham Rd
Glastonbury, CT 06033-2552
Mailing address
200 Wickham Rd
Glastonbury, CT 06033-2552
Phone (860) 778-1551
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Arts, Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001269 | CT | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1670889600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1737936000000",
"number": "1780395590",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 WICKHAM RD",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060332552",
"telephone_number": "860-778-1551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 WICKHAM RD",
"city": "GLASTONBURY",
"state": "CT",
"postal_code": "060332552",
"telephone_number": "860-778-1551"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIVER",
"first_name": "PETER",
"middle_name": "VANNAH",
"credential": "PH.D., LPC, M.A, NCC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-12-13",
"last_updated": "2025-01-27",
"certification_date": "2025-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CT",
"license": "001269",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CT",
"license": "001269",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Glastonbury, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.