Provider Demographics
NPI:1649497645
Name:PETTERSON, BARBARA (MFT)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:PETTERSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4123 BROADWAY # 232
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5111
Mailing Address - Country:US
Mailing Address - Phone:510-501-9192
Mailing Address - Fax:
Practice Address - Street 1:3873 PIEDMONT AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5367
Practice Address - Country:US
Practice Address - Phone:510-501-9192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist