Paul J Peterson, SOCAIL WORK

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

00130-C Issued in NV

Practice address

102 Southend Dr
Dayton, NV 89403-7414

Phone

(775) 328-1298

NPI assigned

Aug 15, 2006

Last updated

Jul 8, 2007By the provider in NPPES

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

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": "1155600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275646465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 SOUTHEND DR",
            "city": "DAYTON",
            "state": "NV",
            "postal_code": "894037414",
            "telephone_number": "775-328-1298"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 SOUTHEND DR",
            "city": "DAYTON",
            "state": "NV",
            "postal_code": "894037414",
            "telephone_number": "775-328-1298"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "PAUL",
        "middle_name": "J",
        "credential": "SOCAIL WORK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NV",
            "license": "00130-C",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nevada State Health Division (Frontier and Rural Public Health)
• Nevada State Health Division/Far Nursin (Frontier and Rural Public Health)
• Northern NV Urgent Care LP (MedDirect Urgent Care)
• Davis Nyariki
• Mary Paredes Ruiz, CHW
• Angela Ponce
• Tamara Proskey
• Andrea Pusatero, LMT
• Kelli Raney
• Tina Maria Rehbein

• Clinical Social Worker in Dayton, NV
• Providers in Dayton, NV by specialty
• Clinical Social Worker in Nevada

• 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.