Provider Demographics
NPI:1407391857
Name:PETRI, ERIN MARIE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:PETRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2609 PICO PL
Mailing Address - Street 2:APT 133
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-3833
Mailing Address - Country:US
Mailing Address - Phone:703-343-0213
Mailing Address - Fax:
Practice Address - Street 1:21077 LYONS VALLEY RD
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:CA
Practice Address - Zip Code:91901-3422
Practice Address - Country:US
Practice Address - Phone:619-401-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-21
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor