MEDICARE: PETERSON Q PHAM LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator
2	1041C0700X	Clinical Social Worker		CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ASW85404	OTHER	CA	BOARD OF BEHAVIORAL SCIENCES

General Provider Information

NPI Number	:	1790107597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PETERSON Q PHAM LCSW

Provider Business Mailing Address
First Line	:	PO BOX 1789
Second Line	:
City	:	GARDEN GROVE
State	:	CA
Zip	:	92842-1789
Country	:	US
Telephone Number	:	657-206-0035
Fax Number	:

Provider Business Practice Location Address
First Line	:	1043 ELM AVE STE 302
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3295
Country	:	US
Telephone Number	:	562-247-7740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/13/2014
Last Update Date	:	11/21/2025

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Directions to “ PETERSON Q PHAM LCSW” Practice Location

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