Provider Demographics
NPI:1023729993
Name:PETERSON, MARNI ANNA (LMFT, DMFT)
Entity type:Individual
Prefix:
First Name:MARNI
Middle Name:ANNA
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LMFT, DMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 MARSHSIDE DR N
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-9152
Mailing Address - Country:US
Mailing Address - Phone:651-434-4977
Mailing Address - Fax:
Practice Address - Street 1:322 MARSHSIDE DR N
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-9152
Practice Address - Country:US
Practice Address - Phone:651-434-4977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4033106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist