MEDICARE: FELISA PETERSEN

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1891181905
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELISA PETERSEN

Provider Business Mailing Address
First Line	:	1917 LAKESHIRE DR
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94595-2444
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2579 SAN PABLO AVE
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-1159
Country	:	US
Telephone Number	:	510-446-7161
Fax Number	:

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

Provider Enumeration Date	:	04/15/2015
Last Update Date	:	04/15/2015

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Directions to “ FELISA PETERSEN ” Practice Location

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