Active NPI
John Edward Peters, PHD
- Clinical Psychologist
- Fairfield, CA
National Provider Identifier
1306018940
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 15056
- Practice address
- 1652 W Texas St Ste 258
Fairfield, CA 94533-5952 - Phone
- (510) 548-5146
- Fax
- (855) 849-5623
- NPI assigned
- Mar 24, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 15056 | CA | Primary |
Addresses
Primary practice location
1652 W Texas St Ste 258
Fairfield, CA 94533-5952
Mailing address
2124 Kittredge St # 834
Berkeley, CA 94704-1486
Phone (510) 548-5146
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120814000134 | CA | Practitioner - Psychologist Billing Independently | 3476709007 | Practice locations: Fairfield, CA; Albany, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1994
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
1035 San Pablo Ave
Suite 5
Albany, CA 94706-2276
Phone (800) 548-2034
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 15056 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1206316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1788825600000",
"number": "1306018940",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2124 KITTREDGE ST # 834",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947041486",
"telephone_number": "510-548-5146",
"fax_number": "855-849-5623"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1652 W TEXAS ST STE 258",
"city": "FAIRFIELD",
"state": "CA",
"postal_code": "945335952",
"telephone_number": "510-548-5146",
"fax_number": "855-849-5623"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "JOHN",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-03-24",
"last_updated": "2026-09-08",
"certification_date": "2026-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 15056",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.