Provider Demographics
NPI:1710151741
Name:DUNLAP, PETER TRASK (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:TRASK
Last Name:DUNLAP
Suffix:
Gender:M
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BODEGA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94952-2666
Mailing Address - Country:US
Mailing Address - Phone:707-782-0400
Mailing Address - Fax:
Practice Address - Street 1:1 BODEGA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2666
Practice Address - Country:US
Practice Address - Phone:707-782-0400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20120103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist