Gordon Wayne Petersen, MSW, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

089-0000142 Issued in VT

Practice address

166 Battery St
Burlington, VT 05401-5283

Phone

(802) 862-3373

NPI assigned

Sep 29, 2006

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

Medicare fee-for-service enrollment

Enrolled in VT

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 Social Worker

Education

Other, 1981

Medicare assignment

Accepts the Medicare-approved amount as payment in full

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.

• Workplace Solutions, Inc.

  • Clinical Social Worker
  • Burlington, VT
  • NPI 1720227325
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1159488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487746244",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "763 NORTH AVE",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054012728",
            "telephone_number": "802-862-9067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "166 BATTERY ST",
            "city": "BURLINGTON",
            "state": "VT",
            "postal_code": "054015283",
            "telephone_number": "802-862-3373"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "GORDON",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "MSW, LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-29",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "VT",
            "license": "089-0000142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Schindler Perzanowski, MD
• Robin M Pesci, LICSW
• Rebecca Peters, DO
• Marissa Nicole Petersen-Coleman, PSYD.
• Christopher Petersen
• Lisa Petersen, LCMHC
• Olivia Frances Petersen
• Gabriella Petrelli, ND
• Gianna Louisa Petrillo, DO
• Kevin Petrillo, MD

• Clinical Social Worker in Burlington, VT
• Providers in Burlington, VT by specialty
• Clinical Social Worker in Vermont

• 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.
• 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.