Provider Demographics
NPI:1376728469
Name:PETERS, CAROLINE M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:M
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 1:3225 HOSPITAL DRIVE
Mailing Address - Street 2:STE 202
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801
Mailing Address - Country:US
Mailing Address - Phone:907-500-7456
Mailing Address - Fax:907-500-7457
Practice Address - Street 1:3225 HOSPITAL DRIVE
Practice Address - Street 2:STE 202
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801
Practice Address - Country:US
Practice Address - Phone:907-500-7456
Practice Address - Fax:907-500-7457
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK58103TC0700X, 103TA0400X, 103TF0000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No171M00000XOther Service ProvidersCase Manager/Care Coordinator