Kimberly Peterson, MA, MFTI

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

65068 Issued in CA

Practice address

1160 N Dutton Ave
Suite 105
Santa Rosa, CA 95401-4600

Phone

(707) 545-2700

NPI assigned

Apr 24, 2012

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Jan 1, 2024 through Jan 1, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Seneca Family of Agencies

  • Community/Behavioral Health Agency
  • Concord, CA
  • NPI 1073643680
  NPD (past)
• Seneca Family of Agencies

  • Community/Behavioral Health Agency
  • Santa Rosa, CA
  • NPI 1205152733
  NPD (past)
• Sonoma Valley Family Therapy PC

  • Mental Health Counselor
  • Sonoma, CA
  • NPI 1205426905
  NPD (past)
• Sonoma Valley Family Therapy PC

  • Mental Health Counselor
  • Sonoma, CA
  • NPI 1881312205
  NPD (past)

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

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383609600000",
    "number": "1225396583",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1160 N DUTTON AVE",
            "address_2": "SUIT 105",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014600",
            "telephone_number": "707-326-9277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1160 N DUTTON AVE",
            "address_2": "SUITE 105",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954014600",
            "telephone_number": "707-545-2700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KIMBERLY",
        "credential": "MA, MFTI",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-24",
        "last_updated": "2013-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "65068",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Dawn Peterson
• Cole Peterson
• Dylan Peterson, DR.
• Jan Louise Peterson, PT
• Jill Peterson
• Scott Paul Peterson, M.D.
• Sherrill Diane Petherbridge, FNP
• Parker William Petray
• Maria M. Petrick, M.D.
• Katherine Pettibone, DPM

• Marriage & Family Therapist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.