Active NPI
Diane V Petz, M.S., L.P.
- Clinical Psychologist
- Winona, MN
National Provider Identifier
1003978024
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP3132
- Practice address
- 66 E 3Rd St
201
Winona, MN 55987-3478 - Phone
- (507) 452-7292
- Fax
- (507) 457-9887
- NPI assigned
- Dec 15, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP3132 | MN | Primary |
Addresses
Primary practice location
66 E 3Rd St
201
Winona, MN 55987-3478
Mailing address
66 E 3Rd St
201
Winona, MN 55987-3478
Phone (507) 452-7292
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 731291024499 | Other | MN | PREFERRED ONE |
| 118043 | Medicaid | MN | |
| 975T0PE | Other | MN | BCBS-MN |
| HP29923 | Other | MN | HEALTHPARTNERS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP3132 | MN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family & Children'S Center, Inc. | Past | Accepting new patients | |
| Family Service of Winona | Past | Accepting new patients |
Organizations & group practices 2
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.
-
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- Winona, MN
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166140800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183939200000",
"number": "1003978024",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "66 E 3RD ST",
"address_2": "201",
"city": "WINONA",
"state": "MN",
"postal_code": "559873478",
"telephone_number": "507-452-7292",
"fax_number": "507-457-9887"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "66 E 3RD ST",
"address_2": "201",
"city": "WINONA",
"state": "MN",
"postal_code": "559873478",
"telephone_number": "507-452-7292",
"fax_number": "507-457-9887"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETZ",
"first_name": "DIANE",
"middle_name": "V",
"credential": "M.S., L.P.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-15",
"last_updated": "2007-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP3132",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PREFERRED ONE",
"identifier": "731291024499",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "118043",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS-MN",
"identifier": "975T0PE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HEALTHPARTNERS",
"identifier": "HP29923",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Winona, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.