MEDICARE: ALLISON PETERSDORF MA PPS, MFT

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
1	106H00000X	Marriage & Family Therapist	53984	CA
2	101YS0200X	School Counselor	240041019	CA

General Provider Information

NPI Number	:	1861347957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON PETERSDORF MA PPS, MFT

Provider Business Mailing Address
First Line	:	2253 FIFTH ST
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4549
Country	:	US
Telephone Number	:	925-606-4709
Fax Number	:

Provider Business Practice Location Address
First Line	:	2253 FIFTH ST
Second Line	:
City	:	LIVERMORE
State	:	CA
Zip	:	94550-4549
Country	:	US
Telephone Number	:	925-606-4709
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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