Active NPI
Jessica Marie Peterson
- Mental Health Counselor
- Sagamore, MA
National Provider Identifier
1194292805
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- Practice address
- 4 Garfield Ave
Sagamore, MA 02561-0718 - Phone
- (774) 994-2928
- NPI assigned
- Oct 31, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | MA | ||
| Mental Health Counselor | 101YM0800X | Primary |
Addresses
Primary practice location
4 Garfield Ave
Sagamore, MA 02561-0718
Mailing address
PO Box 718
Sagamore, MA 02561-0718
Phone (774) 994-2928
Other names 1
- Jessica Marie Peterson
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1589155200000",
"number": "1194292805",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 718",
"city": "SAGAMORE",
"state": "MA",
"postal_code": "025610718",
"telephone_number": "774-994-2928"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 GARFIELD AVE",
"city": "SAGAMORE",
"state": "MA",
"postal_code": "025610718",
"telephone_number": "774-994-2928"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JESSICA",
"middle_name": "MARIE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-31",
"last_updated": "2020-05-11",
"certification_date": "2020-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "MA",
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JESSICA",
"last_name": "PETERSON",
"middle_name": "MARIE",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Sagamore, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.