Provider Demographics
NPI:1689330961
Name:PEDDER, ELIZA ROSE (MA, AMFT, APCC)
Entity Type:Individual
Prefix:
First Name:ELIZA
Middle Name:ROSE
Last Name:PEDDER
Suffix:
Gender:F
Credentials:MA, AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 OLD JONAS HILL RD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5215
Mailing Address - Country:US
Mailing Address - Phone:925-330-2940
Mailing Address - Fax:
Practice Address - Street 1:4155 BLACKHAWK PLAZA CIR STE 101
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4829
Practice Address - Country:US
Practice Address - Phone:925-984-2326
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT127595106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist