Healthcare Provider Details

I. General information

NPI: 1306018940
Provider Name (Legal Business Name): JOHN EDWARD PETERS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 W TEXAS ST STE 258
FAIRFIELD CA
94533-5952
US

IV. Provider business mailing address

2124 KITTREDGE ST # 834
BERKELEY CA
94704-1486
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-5146
  • Fax: 855-849-5623
Mailing address:
  • Phone: 510-548-5146
  • Fax: 855-849-5623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 15056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: