Provider Demographics
NPI:1760699524
Name:PETERSEN, ALLISON RENAE (MS, MFT)
Entity Type:Individual
Prefix:MRS
First Name:ALLISON
Middle Name:RENAE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 STARVIEW WAY
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1229
Mailing Address - Country:US
Mailing Address - Phone:415-920-9971
Mailing Address - Fax:650-655-2797
Practice Address - Street 1:1720 S AMPHLETT BLVD
Practice Address - Street 2:SUITE 118
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2702
Practice Address - Country:US
Practice Address - Phone:650-532-0515
Practice Address - Fax:650-655-2797
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48950106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist