Robin Peterson Psy D LLC

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

ROBIN PETERSON PSY D LLC

Practice address

1035 Lincoln Rd Ste 202
Bettendorf, IA 52722-4149

Phone

(563) 355-4879

NPI assigned

Nov 19, 2021

Organization subpart

No

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

Authorized official

Name

Robin R Peterson, PSY DNPI 1124392477

Title

Clinical Psychologist

Phone

(616) 920-0479

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Robin R. Peterson, PSY.D

  • Psychologist
  • Bettendorf, IA
  • NPI 1124392477
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1637280000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641254400000",
    "number": "1053078477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1035 LINCOLN RD STE 202",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527224149",
            "telephone_number": "563-355-4879"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1035 LINCOLN RD STE 202",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527224149",
            "telephone_number": "563-355-4879"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBIN PETERSON PSY D LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-11-19",
        "last_updated": "2022-01-04",
        "certification_date": "2022-01-04",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "ROBIN",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CLINICAL PSYCHOLOGIST",
        "authorized_official_telephone_number": "616-920-0479",
        "authorized_official_credential": "PSY D"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Bettendorf, IA
• Providers in Bettendorf, IA by specialty
• Psychologist in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.