Tom C Peters, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 3220 Issued in CA

Practice address

4770 Bonvue Ave
Los Angeles, CA 90027-1103

Phone

(323) 666-4270

Fax

(323) 666-7054

NPI assigned

Jan 16, 2007

Sex

Male

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

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.

Opted out of Medicare

Yes, effective Apr 26, 2018 through Apr 26, 2028

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1168905600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1437200409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4770 BONVUE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900271103",
            "telephone_number": "323-666-4270",
            "fax_number": "323-666-7054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4770 BONVUE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900271103",
            "telephone_number": "323-666-4270",
            "fax_number": "323-666-7054"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERS",
        "first_name": "TOM",
        "middle_name": "C",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 3220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CALIFORNIA LICENSE",
            "identifier": "LCS 3220",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Peters
• Mijan Michele Peters
• Randy L Peters
• Stefanie Doyle Peters, PH.D.
• Tiffany Lajaun Peters
• Petersen Holdings Inc.
• Ashlee Petersen, CADC I
• Celia Santana Petersen, LCSW
• Guy Petersen
• Jeffrey Ming Petersen, MD

• All providers in Los Angeles, CA
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.