Provider Demographics
NPI:1831310457
Name:PETROVICH, ANNE S (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:S
Last Name:PETROVICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5151 N PALM
Mailing Address - Street 2:STE 405
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93704
Mailing Address - Country:US
Mailing Address - Phone:559-260-6822
Mailing Address - Fax:559-221-9260
Practice Address - Street 1:5151 N PALM
Practice Address - Street 2:STE 405
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704
Practice Address - Country:US
Practice Address - Phone:559-260-6822
Practice Address - Fax:559-221-9260
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12405103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist