Charles Peterson

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

003293 Issued in CT

Practice address

185 Silas Deane Hwy
Wethersfield, CT 06109

Phone

(860) 698-1680

NPI assigned

Sep 1, 2015

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

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1441065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536624000000",
    "number": "1154798502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1487 LONGMEADOW ST",
            "city": "LONGMEADOW",
            "state": "MA",
            "postal_code": "011062204",
            "telephone_number": "413-726-8716"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "185 SILAS DEANE HWY",
            "city": "WETHERSFIELD",
            "state": "CT",
            "postal_code": "06109",
            "telephone_number": "860-698-1680"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "185 Silas Deane Hwy",
            "address_purpose": "LOCATION",
            "city": "Wethersfield",
            "state": "CT",
            "postal_code": "06109",
            "country_code": "US",
            "telephone_number": "860-698-1680",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1487 Longmeadow St",
            "address_purpose": "LOCATION",
            "city": "Longmeadow",
            "state": "MA",
            "postal_code": "011062204",
            "country_code": "US",
            "telephone_number": "413-726-8716",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CHARLES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-01",
        "last_updated": "2018-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "003293",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "115479-8502",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Professional Counselor in Wethersfield, CT
• Providers in Wethersfield, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; 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.