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General NPI Number Information
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NPI Number | 1306012919
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Entity Type | Individual
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Provider Name | RENA PETERSON PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/03/2008
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 1971 LEE RD
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City | WINTER PARK
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State | FL
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Zip | 32789-1870
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Country | US
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Telephone | 407-450-8151
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Fax |
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Provider Business Mailing Address
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Address Line | 466 WOLDUNN CIR
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City | LAKE MARY
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State | FL
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Zip | 32746-5914
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Country | US
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Telephone | 561-702-9216
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY7702
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License Number State | FL
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