Provider Demographics
NPI:1588827943
Name:PEACOCK, KRISTIN RAE (MSW)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:RAE
Last Name:PEACOCK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:RAE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8233 E STOCKTON BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-8203
Mailing Address - Country:US
Mailing Address - Phone:916-368-3080
Mailing Address - Fax:916-405-6551
Practice Address - Street 1:8233 E STOCKTON BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95828-8203
Practice Address - Country:US
Practice Address - Phone:916-368-3080
Practice Address - Fax:916-405-6551
Is Sole Proprietor?:No
Enumeration Date:2008-07-07
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker