Provider Demographics
NPI:1467609487
Name:PETERSON, JOANNA MARIE (ACSW)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:MARIE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 TUCUMCARI CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-5912
Mailing Address - Country:US
Mailing Address - Phone:916-899-9219
Mailing Address - Fax:
Practice Address - Street 1:3300 DOUGLAS BLVD
Practice Address - Street 2:SUITE 190
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3844
Practice Address - Country:US
Practice Address - Phone:916-787-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical