Provider Demographics
NPI:1831581115
Name:PELTZ, LAWRENCE
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:PELTZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-3976
Mailing Address - Country:US
Mailing Address - Phone:707-545-2728
Mailing Address - Fax:630-839-6371
Practice Address - Street 1:1212 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-3976
Practice Address - Country:US
Practice Address - Phone:707-545-2728
Practice Address - Fax:630-839-6371
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT12862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist