Provider Demographics
NPI:1396637195
Name:PETERSON, MISTY LEE (SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:MISTY
Middle Name:LEE
Last Name:PETERSON
Suffix:
Gender:F
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8564 CARMEL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-9538
Mailing Address - Country:US
Mailing Address - Phone:386-453-9066
Mailing Address - Fax:
Practice Address - Street 1:1410 NATIVIDAD RD
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93906-3102
Practice Address - Country:US
Practice Address - Phone:831-755-3862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1035871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical