Tecya Peterson, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

150.101723 Issued in IL

Practice address

2081 Calistoga Dr
Suite #2S
New Lenox, IL 60451-4831

Phone

(815) 418-6070

Fax

(779) 803-0169

NPI assigned

Sep 19, 2016

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Connections Medical Group Associates LLC

  • Child & Adolescent Psychiatry Physician
  • New Lenox, IL
  • NPI 1548697618
  NPD (past)

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

{
    "created_epoch": "1474243200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1474243200000",
    "number": "1033667167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "917 W WASHINGTON BLVD",
            "address_2": "SUITE 113",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606072203",
            "telephone_number": "815-418-6070",
            "fax_number": "779-803-0169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2081 CALISTOGA DR",
            "address_2": "SUITE #2S",
            "city": "NEW LENOX",
            "state": "IL",
            "postal_code": "604514831",
            "telephone_number": "815-418-6070",
            "fax_number": "779-803-0169"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "TECYA",
        "credential": "LSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2016-09-19",
        "last_updated": "2016-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150.101723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE",
            "identifier": "150.101723",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pediatric Dental Specialty Associates LTD
• Sean Pedley, DNP
• Jose Antonio Penaherrera, M.D.
• Mia Y Perri
• Eric Jon Petecki, O.D.
• Robert Pieczynski
• Gamilah N. Pierre, M.D.
• Arnold Victor Pilmonas
• Loreal Jeanne Pinder, LMT
• Janaya Faith Pinnick

• Social Worker in New Lenox, IL
• Providers in New Lenox, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2016; 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.