Provider Demographics
NPI:1942424726
Name:PETERSEN, ELIZABETH ANNE
Entity Type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 N MARKET BLVD STE 350
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-1238
Mailing Address - Country:US
Mailing Address - Phone:916-922-2771
Mailing Address - Fax:
Practice Address - Street 1:601 N MARKET BLVD STE 350
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-1238
Practice Address - Country:US
Practice Address - Phone:916-922-2771
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor