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General NPI Number Information
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NPI Number | 1639729254
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Entity Type | Individual
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Provider Name | STACEY ELIZABETH PETROWSKY MA, LMFT
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Gender | Female
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Dates
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Enumeration Date | 09/16/2019
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Last Update Date | 12/05/2019
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Provider Practice Location Address
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Address Line | 1910 OLYMPIC BLVD STE 210A
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5096
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Country | US
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Telephone | 925-984-4463
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Fax |
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Provider Business Mailing Address
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Address Line | 1215 HONEY TRL
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City | WALNUT CREEK
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State | CA
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Zip | 94597-2126
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Country | US
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Telephone | 925-378-3978
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 115466
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License Number State | CA
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