Provider Demographics
NPI:1093860041
Name:PETERSON, D. SARAH (LICSW)
Entity Type:Individual
Prefix:MS
First Name:D.
Middle Name:SARAH
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 MAIN ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3096
Mailing Address - Country:US
Mailing Address - Phone:425-771-5432
Mailing Address - Fax:
Practice Address - Street 1:611 MAIN ST
Practice Address - Street 2:SUITE F
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3096
Practice Address - Country:US
Practice Address - Phone:425-771-5432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000046971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA601-182-432-001-0001OtherUBI
WA601-182-432-001-0001OtherUBI