Provider Demographics
NPI:1881818185
Name:PETERSON, REBECCA KAREN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:KAREN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13949 VENTURA BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3570
Mailing Address - Country:US
Mailing Address - Phone:818-907-9518
Mailing Address - Fax:818-898-3382
Practice Address - Street 1:13949 VENTURA BLVD STE 210
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3570
Practice Address - Country:US
Practice Address - Phone:818-907-9518
Practice Address - Fax:818-898-3382
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21382103T00000X, 103TC1900X
CAMFT33954106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist