Provider Demographics
NPI:1831136464
Name:PETERS, LAURA JEAN
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:JEAN
Last Name:PETERS
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:LAURA
Other - Middle Name:PETERS
Other - Last Name:KATZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:VAPAHCS WBRC 124
Mailing Address - Street 2:3801 MIRANDA AVENUE
Mailing Address - City:PALO ALTO
Mailing Address - State:CO
Mailing Address - Zip Code:94304
Mailing Address - Country:US
Mailing Address - Phone:650-852-3468
Mailing Address - Fax:650-852-3472
Practice Address - Street 1:VAPAHCS WBRC 124
Practice Address - Street 2:3801 MIRANDA AVENUE
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304
Practice Address - Country:US
Practice Address - Phone:650-852-3468
Practice Address - Fax:650-852-3472
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11247103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation