Provider Demographics
NPI:1386777043
Name:PETERSON, SHARON ANN (MA)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3331 POWER INN RD
Mailing Address - Street 2:190
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-3889
Mailing Address - Country:US
Mailing Address - Phone:916-875-9864
Mailing Address - Fax:916-875-9894
Practice Address - Street 1:3331 POWER INN RD
Practice Address - Street 2:190
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-3889
Practice Address - Country:US
Practice Address - Phone:916-875-9864
Practice Address - Fax:916-875-9894
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101Y00000XOtherMHRS