Provider Demographics
NPI:1417168444
Name:PEARSON, PETER (PHD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:445 BURGESS DR
Mailing Address - Street 2:SUITE #150
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3442
Mailing Address - Country:US
Mailing Address - Phone:650-327-5915
Mailing Address - Fax:
Practice Address - Street 1:445 BURGESS DR
Practice Address - Street 2:SUITE #150
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3442
Practice Address - Country:US
Practice Address - Phone:650-327-5915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY6831103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist