Provider Demographics
NPI:1356478978
Name:PETERSEN, KARI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:KARI
Middle Name:
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1240 POWELL ST
Mailing Address - Street 2:STE 2-D
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2600
Mailing Address - Country:US
Mailing Address - Phone:510-393-0171
Mailing Address - Fax:
Practice Address - Street 1:1240 POWELL ST
Practice Address - Street 2:STE 2-D
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2600
Practice Address - Country:US
Practice Address - Phone:510-393-0171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 221421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical