Louise Urbanc Peters, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PY7171 Issued in FL

Practice address

6103 N Atlantic Ave
Ste C
Cape Canaveral, FL 32920-3976

Phone

(321) 514-2878

Fax

(954) 944-0308

NPI assigned

May 22, 2006

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 3

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2000

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ketamine Holistic Wellness Center, PLLC

  • Psychiatric/Mental Health Registered Nurse
  • Satellite Beach, FL
  • NPI 1114586138
  NPD
• Gasnet Inc

  • Certified Registered Nurse Anesthetist
  • Cape Canaveral, FL
  • NPI 1598237869
  NPD (past)
• South Brevard Women's Center, Inc

  • Mental Health Counselor
  • Melbourne, FL
  • NPI 1659324523
  NPD (past)

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

{
    "created_epoch": "1148256000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1639094400000",
    "number": "1386699213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3730 BIG PINE RD",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329348536",
            "telephone_number": "321-259-2745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6103 N ATLANTIC AVE",
            "address_2": "STE C",
            "city": "CAPE CANAVERAL",
            "state": "FL",
            "postal_code": "329203976",
            "telephone_number": "321-514-2878",
            "fax_number": "954-944-0308"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "LOUISE",
        "middle_name": "URBANC",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-22",
        "last_updated": "2021-12-10",
        "certification_date": "2021-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY7171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "5C57A98C68",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER NUMBER",
            "identifier": "75323",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS PROVIDER #",
            "identifier": "558343",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael D Moulton, PHARMD, RPH
• Jessica Nixon, M. ED.
• Gwendolynne Elizabeth Noack, LMT
• North Brevard Medical Support, Inc
• Tamara Pawich, PH.D., BCBA-D
• Ridgemoor Case Management Services Inc.
• Grace Rodes, RPH
• Alejandro Javier Romero, IDHS
• Lijah Lyndon Rosario
• Julian Benedict Salido, IDHS

• Clinical Psychologist in Cape Canaveral, FL
• Providers in Cape Canaveral, FL by specialty
• Clinical Psychologist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.

Verify at the official NPI Registry.