Katrina Larea Pettersen, LEP 4489

Primary specialty

School PsychologistTaxonomy code 103TS0200X

License

4489 Issued in CA

Practice address

1261 Lincoln Ave Ste 104
San Jose, CA 95125-3030

Phone

(408) 439-1111

NPI assigned

Dec 5, 2024

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1733356800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1104632991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2893 UNION AVE",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951241435",
            "telephone_number": "760-902-8990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1261 LINCOLN AVE STE 104",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951253030",
            "telephone_number": "408-439-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTERSEN",
        "first_name": "KATRINA",
        "middle_name": "LAREA",
        "credential": "LEP 4489",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-05",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TS0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, School",
            "state": "CA",
            "license": "4489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Petros, M.D.
• Ramiz R Petros, D.M.D
• Tigran Petrosyan
• Mirena Petrous, RN
• Craig Alan Pettengill, D.D.S.
• Timothy William Pettett, SUDRC #16547
• Kyle Pettit, M.A.
• Mahleiah Amele Pettus-Johnson
• Manju Simha Petty, LMFT
• Steve Petty, MD

• School Psychologist in San Jose, CA
• Providers in San Jose, CA by specialty
• School Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.