Provider Demographics
NPI:1508114190
Name:PETERSON, VERONIQUE (PHD)
Entity Type:Individual
Prefix:
First Name:VERONIQUE
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 BUTTE HOUSE RD.
Mailing Address - Street 2:SUITE F
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95993-2749
Mailing Address - Country:US
Mailing Address - Phone:530-751-1122
Mailing Address - Fax:530-751-1122
Practice Address - Street 1:1445 BUTTE HOUSE RD.
Practice Address - Street 2:SUITE F
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-2749
Practice Address - Country:US
Practice Address - Phone:530-751-1122
Practice Address - Fax:530-751-1122
Is Sole Proprietor?:No
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25175103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical