Provider Demographics
NPI:1417327644
Name:COSTER, PETER H (MDIV, PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:H
Last Name:COSTER
Suffix:
Gender:M
Credentials:MDIV, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 DONNER AVE
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-7135
Mailing Address - Country:US
Mailing Address - Phone:707-996-1363
Mailing Address - Fax:
Practice Address - Street 1:1730 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2140
Practice Address - Country:US
Practice Address - Phone:510-548-1713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-30
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24853106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist