Dr. Kirsten E. Petersen Psychological Services, PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

DR. KIRSTEN E. PETERSEN PSYCHOLOGICAL SERVICES, PLLC

Practice address

2389 Babylon St
Wantagh, NY 11793-4501

Phone

(917) 991-1042

NPI assigned

Jun 16, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Kirsten Erin PetersenNPI 1831581594

Title

Owner

Phone

(917) 991-1042

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kirsten E Petersen, PhD Doing business as

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kirsten E Petersen, PHD

  • Clinical Psychologist
  • Wantagh, NY
  • NPI 1831581594
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1592265600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1592352000000",
    "number": "1366067258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2389 BABYLON ST",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117934501",
            "telephone_number": "917-991-1042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2389 BABYLON ST",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117934501",
            "telephone_number": "917-991-1042"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. KIRSTEN E. PETERSEN PSYCHOLOGICAL SERVICES, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-16",
        "last_updated": "2020-06-17",
        "certification_date": "2020-06-17",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "KIRSTEN",
        "authorized_official_middle_name": "ERIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "917-991-1042",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEACON HEALTH OPTIONS",
            "identifier": "901260",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EMPIRE BLUECROSS BLUESHIELD",
            "identifier": "V53P52",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kirsten E Petersen, PhD",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kirsten E Petersen, PhD",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kristin Marie Dione
• DM Pharmacy,Inc.
• Ellen L Dombrowski, NP
• Michael Edward Donnelly, LMT
• Dr Mitchell Brookstone DDS PC
• Dr. Rachell Pierre-Louis, Psychologist, PC
• Debra Ann Drago, RD, CDN
• Jessica Lynn Draude
• Christopher Dressler
• Suzanne Dressler

• Clinical Psychologist in Wantagh, NY
• Providers in Wantagh, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.