John Peterson, LISW, CDCA

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

I1801316 Issued in OH

Practice address

733 Market Ave S
Canton, OH 44702-2165

Phone

(330) 489-4600

NPI assigned

May 12, 2016

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 1

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": "1463011200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543536000000",
    "number": "1023464682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1341 MARKET AVE N",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447142605",
            "telephone_number": "330-453-8252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "733 MARKET AVE S",
            "city": "CANTON",
            "state": "OH",
            "postal_code": "447022165",
            "telephone_number": "330-489-4600"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1341 Market Ave N",
            "address_purpose": "LOCATION",
            "city": "Canton",
            "state": "OH",
            "postal_code": "447142605",
            "country_code": "US",
            "telephone_number": "330-453-8252",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JOHN",
        "credential": "LISW, CDCA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-05-12",
        "last_updated": "2018-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "0012311",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "011229",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OH",
            "license": "I1801316",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2901131",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bonnie Sue Peterson, LPCC
• Cherrelle L Peterson
• Darryl Wayne Peterson II
• Deonna Peterson
• Desirea Peterson
• Natatia Monique Peterson, CD, PCD, DEM
• Tianna Ty'Sha Peterson
• Michael Petrides, DDS
• Pete Angelo Petrides, DDS, MPH
• Amie Marie Petrik

• Clinical Social Worker in Canton, OH
• Providers in Canton, OH by specialty
• Clinical Social Worker in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2018; 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.