Amy K Petersdorf, MA

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

4667-125 Issued in WI

Practice address

10702 W Burleigh St
Wauwatosa, WI 53222-3310

Phone

(414) 777-0740

Fax

(414) 777-0749

NPI assigned

Jan 25, 2011

Last updated

Feb 7, 2017By the provider in NPPES

Sex

Female

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

Enrolled in WI

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.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2009

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Associated Mental Health Consultants IncGroup PAC ID 5597665026, 8 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Arts

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Associated Mental Health Consultants Inc

  • Psychiatry Physician
  • Wauwatosa, WI
  • NPI 1063437986
  Medicare reassignment Care Compare group
• Solutions Behavioral Health Group, SC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Mequon, WI
  • NPI 1487701645
  NPD (past)

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

{
    "created_epoch": "1295913600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486425600000",
    "number": "1235434176",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10702 W BURLEIGH ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532223310",
            "telephone_number": "414-777-0740",
            "fax_number": "414-777-0749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10702 W BURLEIGH ST",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532223310",
            "telephone_number": "414-777-0740",
            "fax_number": "414-777-0749"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSDORF",
        "first_name": "AMY",
        "middle_name": "K",
        "credential": "MA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-25",
        "last_updated": "2017-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "WI",
            "license": "4667-125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Thomas J Perlewitz, MD
• Perry W Sukowatey DDS LTD
• Madalyn Jessica Perry, D.C
• Suncerrae Perry, MSW, APSW, SAC-IT
• Roy Perteet
• Talya Marie Petersik, M.S.
• Peterson Lactation Services (Not Applicable)
• Kimberly Anne Peterson, M.A. CCC-SLP
• Molly G Peterson, BS, IBCLC, RLC
• Tracy M Peterson, NURSE PRACTIONER

• Professional Counselor in Wauwatosa, WI
• Providers in Wauwatosa, WI by specialty
• Professional Counselor in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.