Kathryn Petersen, MA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-13-14878 Issued in CA

Practice address

6540 Lusk Blvd Ste C256
San Diego, CA 92121-5795

Phone

(858) 657-9117

NPI assigned

Nov 18, 2013

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

Practice roles

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

• 2 Steps Forward Consulting, Inc.

  • Behavior Analyst
  • Poway, CA
  • NPI 1538842133
  NPD Authorized official
• Applied Interventions & Methodologies, Inc.

  • Local Education Agency (LEA)
  • San Diego, CA
  • NPI 1265633689
  NPD (past)

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

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1384732800000",
    "number": "1487084091",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13325 CALLE DEL CAMPO UNIT 2",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921294687",
            "telephone_number": "858-361-0670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6540 LUSK BLVD STE C256",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921215795",
            "telephone_number": "858-657-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KATHRYN",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-11-18",
        "last_updated": "2013-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-13-14878",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brett Petersen, M.D.
• David A Petersen, MD
• George Justin Petersen, DPT
• Henry Soron Petersen, L.C.S.W.
• Kate Petersen
• Kaylee Petersen, ARNP
• Michelle Ann Petersen
• Mihaela E Petersen, M.D.
• Neal Christopher Petersen, CRNA
• Nicole Michelle Petersen

• Behavior Analyst in San Diego, CA
• Providers in San Diego, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; 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.