Active NPI
Melanie Leeann Petersen
- Clinical Social Worker
- Bryan, TX
National Provider Identifier
1487469839
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 115176
- Practice address
- 3003 Stevens Dr
Bryan, TX 77803-2593 - Phone
- (402) 417-2076
- NPI assigned
- Feb 12, 2025
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 115176 | TX | Primary |
Addresses
Primary practice location
3003 Stevens Dr
Bryan, TX 77803-2593
Mailing address
3003 Stevens Dr
Bryan, TX 77803-2593
Phone (402) 417-2076
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 115176 | TX | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739318400000",
"number": "1487469839",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3003 STEVENS DR",
"city": "BRYAN",
"state": "TX",
"postal_code": "778032593",
"telephone_number": "402-417-2076"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3003 STEVENS DR",
"city": "BRYAN",
"state": "TX",
"postal_code": "778032593",
"telephone_number": "402-417-2076"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "MELANIE",
"middle_name": "LEEANN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-12",
"last_updated": "2025-02-12",
"certification_date": "2025-02-12",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "115176",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bryan, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.