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General NPI Number Information
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NPI Number | 1881818185
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Entity Type | Individual
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Provider Name | REBECCA KAREN PETERSON PSYD
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Gender | Female
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Dates
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Enumeration Date | 04/11/2007
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 13949 VENTURA BLVD STE 210
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-3570
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Country | US
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Telephone | 818-907-9518
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Fax | 818-898-3382
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Provider Business Mailing Address
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Address Line | 13949 VENTURA BLVD STE 210
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-3570
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Country | US
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Telephone | 818-907-9518
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Fax | 818-898-3382
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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 | PSY21382
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY21382
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFT33954
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License Number State | CA
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