Casey Brian Petersen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

7392336-3501 Issued in UT

Practice address

50 N Medical Dr
Salt Lake City, UT 84132-0001

Phone

(801) 581-2121

NPI assigned

Nov 18, 2017

Sex

Male

Sole proprietor

No

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

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Nov 26, 2018 through Nov 26, 2026

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.

• LDS Family Services

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Renton, WA
  • NPI 1073726485
  NPD (past)

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

{
    "created_epoch": "1510963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1114431772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11656 S OAKMOND RD",
            "city": "SOUTH JORDAN",
            "state": "UT",
            "postal_code": "840095049",
            "telephone_number": "801-643-3332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "50 N MEDICAL DR",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001",
            "telephone_number": "801-581-2121"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "833 E 9400 S",
            "address_purpose": "LOCATION",
            "city": "Sandy",
            "state": "UT",
            "postal_code": "840943655",
            "country_code": "US",
            "telephone_number": "801-566-2556",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "CASEY",
        "middle_name": "BRIAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-18",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "7392336-3501",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anthony Michael Petersen, M.D.
• Brett Petersen
• Brian Lamar Petersen, LCSW
• Brittany J Petersen, LMFT, LPC, CMHC
• Byron Thad Petersen, D.D.S.
• Catherine Adriana Petersen
• Chrissa Petersen
• David B Petersen, MD
• Elaine Petersen, OTR/L
• Finn Bo Petersen, M.D.

• Clinical Social Worker in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.