David Petersen, PH.D.

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

03772 Issued in MD

Practice address

University of Maryland
1209 Shoemaker Building
College Park, MD 20742-0001

Phone

(301) 314-9792

NPI assigned

May 25, 2007

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 names 1

• Dr. David A. Petersen Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1180051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1164633632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14724 LOCUSTWOOD LN",
            "city": "SILVER SPRING",
            "state": "MD",
            "postal_code": "209056424",
            "telephone_number": "301-388-0650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UNIVERSITY OF MARYLAND",
            "address_2": "1209 SHOEMAKER BUILDING",
            "city": "COLLEGE PARK",
            "state": "MD",
            "postal_code": "207420001",
            "telephone_number": "301-314-9792"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-25",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "03772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "DAVID",
            "last_name": "PETERSEN",
            "middle_name": "A.",
            "prefix": "DR.",
            "credential": "PH.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Mental Health Counselor in College Park, MD
• Providers in College Park, MD by specialty
• Mental Health Counselor in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.