Provider Demographics
NPI:1366522419
Name:PETERSON, CHRISTINE SAGEN (PHD)
Entity type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:SAGEN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5135 CAMINO FLORAL
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93111-2906
Mailing Address - Country:US
Mailing Address - Phone:805-698-6959
Mailing Address - Fax:805-967-5646
Practice Address - Street 1:539 SAN YSIDRO RD FL 2
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93108-2195
Practice Address - Country:US
Practice Address - Phone:805-698-6959
Practice Address - Fax:805-967-5646
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 6929103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist