Provider Demographics
NPI:1538280854
Name:PETERSON, MARION MACPHAIL (RN MFT)
Entity Type:Individual
Prefix:MRS
First Name:MARION
Middle Name:MACPHAIL
Last Name:PETERSON
Suffix:
Gender:F
Credentials:RN MFT
Other - Prefix:MRS
Other - First Name:MARNIE
Other - Middle Name:MACPHAIL
Other - Last Name:PETERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN MFT
Mailing Address - Street 1:1756 LACASSIE AVENUE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-7002
Mailing Address - Country:US
Mailing Address - Phone:925-933-8300
Mailing Address - Fax:510-843-0276
Practice Address - Street 1:1756 LACASSIE AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-7002
Practice Address - Country:US
Practice Address - Phone:925-933-8300
Practice Address - Fax:510-843-0276
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 32921106H00000X
CARN 233108163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Not Answered163W00000XNursing Service ProvidersRegistered Nurse