Provider Demographics
NPI:1932069978
Name:CORTINA PETRASIC, MACARENA (MA, AMFT)
Entity type:Individual
Prefix:
First Name:MACARENA
Middle Name:
Last Name:CORTINA PETRASIC
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:565 BRUNSWICK RD STE 2
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-9529
Mailing Address - Country:US
Mailing Address - Phone:628-245-5259
Mailing Address - Fax:
Practice Address - Street 1:2903 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2509
Practice Address - Country:US
Practice Address - Phone:415-715-9583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-13
Last Update Date:2025-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA159438101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor