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NPI Code Detail

MEDICARE: MACARENA CORTINA PETRASIC MA, AMFT

MEDICARE: MACARENA CORTINA PETRASIC MA, AMFT
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
1101Y00000XCounselor159438CA

General Provider Information

NPI Number : 1932069978
Entity Type Code : Individual
Provider Name (Legal Business Name) : MACARENA CORTINA PETRASIC MA, AMFT
Provider Business Mailing Address
First Line : 565 BRUNSWICK RD STE 2
Second Line :
City : GRASS VALLEY
State : CA
Zip : 95945-9529
Country : US
Telephone Number : 628-245-5259
Fax Number :
Provider Business Practice Location Address
First Line : 2903 SACRAMENTO ST
Second Line :
City : BERKELEY
State : CA
Zip : 94702-2509
Country : US
Telephone Number : 415-715-9583
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/13/2025
Last Update Date : 11/13/2025

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