Provider Demographics
NPI:1710046594
Name:ADAMS, PETER J (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:ADAMS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5007 PALMETTO AVE
Mailing Address - Street 2:SUITE 42
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3027
Mailing Address - Country:US
Mailing Address - Phone:916-549-1102
Mailing Address - Fax:
Practice Address - Street 1:3550 WATT AVE STE 140
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95821-2666
Practice Address - Country:US
Practice Address - Phone:916-549-1102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16772103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical