Provider Demographics
NPI:1861766172
Name:PETERSEN, TRISHA MARCIA (LCSW)
Entity type:Individual
Prefix:MS
First Name:TRISHA
Middle Name:MARCIA
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1447
Mailing Address - Country:US
Mailing Address - Phone:518-462-7259
Mailing Address - Fax:518-462-7265
Practice Address - Street 1:108 WHITEHALL RD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12209-1447
Practice Address - Country:US
Practice Address - Phone:518-462-7259
Practice Address - Fax:518-462-7265
Is Sole Proprietor?:No
Enumeration Date:2012-03-05
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY730409781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical