Provider Demographics
NPI:1104010966
Name:PETERS, ALLISON CATHERINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:CATHERINE
Last Name:PETERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1452 26TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-3084
Mailing Address - Country:US
Mailing Address - Phone:310-922-7819
Mailing Address - Fax:
Practice Address - Street 1:1452 26TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-3084
Practice Address - Country:US
Practice Address - Phone:310-922-7819
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical