Provider Demographics
NPI:1841683257
Name:PETERMAN, JEREMY
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:PETERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 TAMAL PLZ STE 235
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1070
Mailing Address - Country:US
Mailing Address - Phone:415-297-0815
Mailing Address - Fax:
Practice Address - Street 1:200 TAMAL PLZ STE 235
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1070
Practice Address - Country:US
Practice Address - Phone:415-297-0815
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-09
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist