Timothy Allen Petersen, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY 19159 Issued in CA

Practice address

16055 Ventura Blvd
Suite 920
Encino, CA 91436-2601

Phone

(818) 377-6330

NPI assigned

Nov 5, 2008

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: timothypetersen-tarzanatc@lacsapc.netsmartdirect.net

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.

• Los Angeles County Department of Public Health

  • Public Health or Welfare Agency
  • Alhambra, CA
  • NPI 1700090834
  NPD

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

{
    "created_epoch": "1225843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1225843200000",
    "number": "1104070119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16055 VENTURA BLVD",
            "address_2": "SUITE 920",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362601",
            "telephone_number": "818-377-6330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16055 VENTURA BLVD",
            "address_2": "SUITE 920",
            "city": "ENCINO",
            "state": "CA",
            "postal_code": "914362601",
            "telephone_number": "818-377-6330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "TIMOTHY",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-11-05",
        "last_updated": "2008-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "CA",
            "license": "PSY 19159",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Personal Touch Hospice Care Inc
• Laura Flicker Pescione, PH.D
• Peter C Nissler DDS a Dental Corp
• Peter R. Shrier, M.D.
• Glenn Allen Peters, PHD
• Kenneth P Peterson, MD
• Stephanie Marie Pettigrew
• Peyman Gravori, D.O. Inc., a Professional Medical Corporation
• Cynthia Pezeshgian, NP
• Beata Pezeshki, DDS

• Psychologist in Encino, CA
• Providers in Encino, CA by specialty
• Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2008; 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.