Rebecca L. Petersen, LCSW, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

008697 Issued in CT

Legal business name

REBECCA L. PETERSEN, LCSW, LLC

Practice address

147 Durham Rd
Oak Park
Madison, CT 06443-2675

Phone

(860) 227-6839

NPI assigned

Jul 30, 2015

Organization subpart

No

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

Authorized official

Name

Mrs. Rebecca Lee Petersen, LCSWNPI 1124352174

Title

Owner/Psychotherapist

Phone

(860) 227-6839

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

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

• Rebecca Lee Petersen

  • Clinical Social Worker
  • Madison, CT
  • NPI 1124352174
  NPD (past) Authorized official

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

{
    "created_epoch": "1438214400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1438214400000",
    "number": "1437535580",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 VACCINIUM WAY",
            "city": "OLD LYME",
            "state": "CT",
            "postal_code": "063712809",
            "telephone_number": "860-227-6839",
            "fax_number": "203-643-2204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "147 DURHAM RD",
            "address_2": "OAK PARK",
            "city": "MADISON",
            "state": "CT",
            "postal_code": "064432675",
            "telephone_number": "860-227-6839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REBECCA L. PETERSEN, LCSW, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-30",
        "last_updated": "2015-07-30",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "OWNER/PSYCHOTHERAPIST",
        "authorized_official_telephone_number": "860-227-6839",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "008697",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008056034",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kaitlin C Quallen, MD
• Rita Rabheru, MD
• Nicholas Geoffrey Rapport
• Rounak Babula Rawal, M.D.
• Nicholas Alexander Read, DO
• Recovery Services of Connecticut, LLC
• Recovery Services of Connecticut, LLC
• Aaisma Regmi, LSW
• Michelle Monaco Reynolds, PH.D.
• Lori Richardson, DC

• Clinical Social Worker in Madison, CT
• Providers in Madison, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2015; 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.