Active NPI
Sandra Joan Peters, LMHC
- Mental Health Counselor
- Southborough, MA
National Provider Identifier
1376630004
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 5043
- Practice address
- 11 Ledge Hill Rd
Southborough, MA 01772-1116 - Phone
- (617) 777-4959
- Fax
- (508) 229-0679
- NPI assigned
- Oct 6, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 5043 | MA | Primary |
Addresses
Primary practice location
11 Ledge Hill Rd
Southborough, MA 01772-1116
Mailing address
11 Ledge Hill Rd
Southborough, MA 01772-1116
Phone (617) 777-4959
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 13, 2024 through Mar 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LMHC | MA | MD | Mental Health Counselor |
| 5043 | MA | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1160092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1328832000000",
"number": "1376630004",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11 LEDGE HILL RD",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "017721116",
"telephone_number": "617-777-4959",
"fax_number": "508-229-0679"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 LEDGE HILL RD",
"city": "SOUTHBOROUGH",
"state": "MA",
"postal_code": "017721116",
"telephone_number": "617-777-4959",
"fax_number": "508-229-0679"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERS",
"first_name": "SANDRA",
"middle_name": "JOAN",
"name_prefix": "Mrs.",
"credential": "LMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-06",
"last_updated": "2012-02-10",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "MA",
"license": "5043",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southborough, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.