Connie Karol Peterson

Primary specialty

Marriage & Family TherapistTaxonomy code 106H00000X

License

82428 Issued in CA

Practice address

1891 E Roseville Pkwy Ste 100
Roseville, CA 95661-7974

Phone

(916) 789-7082

NPI assigned

Jul 27, 2017

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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 and National Provider Directory roles.

• Kenneth L. Larson, PH.D., Inc.

  • Clinical Psychologist
  • Roseville, CA
  • NPI 1609396183
  NPD (past)
• Travis H Owens Psy D Inc

  • Clinical Psychologist
  • Roseville, CA
  • NPI 1275762452
  NPD (past)

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

{
    "created_epoch": "1501113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1529107200000",
    "number": "1346764859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1891 E ROSEVILLE PKWY STE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956617974",
            "telephone_number": "916-789-7082"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1891 E ROSEVILLE PKWY STE 100",
            "city": "ROSEVILLE",
            "state": "CA",
            "postal_code": "956617974",
            "telephone_number": "916-789-7082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "CONNIE",
        "middle_name": "KAROL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-07-27",
        "last_updated": "2018-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "82428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MARRIAGE AND FAMILY THERAPIST",
            "identifier": "106H00000X",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Randy Petersen, ND (TRADITIONAL)
• Alan Gunnar Peterson, PA
• Barry Alan Peterson, PHARMD
• Bart J Peterson, PA
• Brett A Peterson, P.T.
• Joanna Marie Peterson, ACSW
• Katherine E. Peterson, PT
• Kelsey Peterson
• Tracey Peterson
• Denys Petrovych

• Marriage & Family Therapist in Roseville, CA
• Providers in Roseville, CA by specialty
• Marriage & Family Therapist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.