Provider Demographics
NPI:1124231428
Name:PETERSEN, BRENT H (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:H
Last Name:PETERSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 WESTWIND DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3028
Mailing Address - Country:US
Mailing Address - Phone:661-632-1849
Mailing Address - Fax:661-632-1866
Practice Address - Street 1:1801 WESTWIND DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3028
Practice Address - Country:US
Practice Address - Phone:661-632-1849
Practice Address - Fax:661-632-1866
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 229571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical