Provider Demographics
NPI:1376882654
Name:PETERSON, JANET W (M D)
Entity Type:Individual
Prefix:MRS
First Name:JANET
Middle Name:W
Last Name:PETERSON
Suffix:
Gender:F
Credentials:M D
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:U
Other - Last Name:WESTBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:M D
Mailing Address - Street 1:112 SUGARLOAF DR
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-1624
Mailing Address - Country:US
Mailing Address - Phone:415-435-1101
Mailing Address - Fax:
Practice Address - Street 1:112 SUGARLOAF DR
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-1624
Practice Address - Country:US
Practice Address - Phone:415-435-1101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE193262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry