Rebecca Lee Petersen

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

008697 Issued in CT

Practice address

147 Durham Rd
Oak Park
Madison, CT 06443-2675

Phone

(860) 227-6839

Fax

(860) 227-6839

NPI assigned

Sep 23, 2009

Sex

Female

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)

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.

• Rebecca L. Petersen, LCSW, LLC

  • Clinical Social Worker
  • Madison, CT
  • NPI 1437535580
  NPD (past) Authorized official

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

{
    "created_epoch": "1253664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1417564800000",
    "number": "1124352174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 VACCINIUM WAY",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "063712809",
            "telephone_number": "860-227-6839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 DURHAM RD",
            "address_2": "OAK PARK",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064432675",
            "telephone_number": "860-227-6839",
            "fax_number": "860-227-6839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "REBECCA",
        "middle_name": "LEE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2009-09-23",
        "last_updated": "2014-12-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "008697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mary Norcott Pemberton, LCSW
• Amanda Rose Perez, DNP, FNP-C
• W. Dean Pfeifer, PHD
• Physical Therapy and Wellness Treatment Center, LLC
• Physical Therapy Center of Madison
• Taylor Marie Pisano, LMFT
• Christina Marie Polk

• Clinical Social Worker in Madison, CT
• Providers in Madison, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2014; 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.