Provider Demographics
NPI:1003025586
Name:PETERSEN, KARENA CAIA (MARRIAGE FAMILY THER)
Entity Type:Individual
Prefix:MS
First Name:KARENA
Middle Name:CAIA
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MARRIAGE FAMILY THER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:137 E HAMILTON AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-0244
Mailing Address - Country:US
Mailing Address - Phone:408-772-0644
Mailing Address - Fax:408-364-1684
Practice Address - Street 1:137 E HAMILTON AVE STE 204
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-0244
Practice Address - Country:US
Practice Address - Phone:408-772-0644
Practice Address - Fax:408-364-1684
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2019-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38953106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist