Provider Demographics
NPI:1588726665
Name:PETERS, KAREN ANNE (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANNE
Last Name:PETERS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14710 LLAGAS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARTIN
Mailing Address - State:CA
Mailing Address - Zip Code:95046-9202
Mailing Address - Country:US
Mailing Address - Phone:408-366-4225
Mailing Address - Fax:408-366-4201
Practice Address - Street 1:19000 HOMESTEAD RD
Practice Address - Street 2:CDRP
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0712
Practice Address - Country:US
Practice Address - Phone:408-366-4225
Practice Address - Fax:408-366-4201
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15572103TA0400X, 208VP0000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine