Provider Demographics
NPI:1801830393
Name:PETERSON, BARBARA JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:JOAN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1910 OLYMPIC BLVD
Mailing Address - Street 2:SUITE 230
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-5096
Mailing Address - Country:US
Mailing Address - Phone:925-939-4147
Mailing Address - Fax:925-939-4159
Practice Address - Street 1:1910 OLYMPIC BLVD
Practice Address - Street 2:SUITE 230
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-5096
Practice Address - Country:US
Practice Address - Phone:925-939-4147
Practice Address - Fax:925-939-4159
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 9319103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical