Active NPI
Deland R Peterson, PHD
- Clinical Psychologist
- Mather, CA
National Provider Identifier
1568495497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 961
- Practice address
- 10535 Hospital Way
VA Nchcs
Mather, CA 95655 - Phone
- (916) 366-5431
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PY0469 | NV | |
| Clinical Psychologist | 103TC0700X | 961 | KY | Primary |
Addresses
Primary practice location
10535 Hospital Way
VA Nchcs
Mather, CA 95655
Mailing address
10535 Hospital Way
VA Nchcs
Mather, CA 95655
Phone (916) 366-5431
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 961 | KY | MD | Clinical Psychologist |
| PY0469 | NV | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1245801600000",
"number": "1568495497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10535 HOSPITAL WAY",
"address_2": "VA NCHCS",
"city": "MATHER",
"state": "CA",
"postal_code": "95655",
"telephone_number": "916-366-5431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10535 HOSPITAL WAY",
"address_2": "VA NCHCS",
"city": "MATHER",
"state": "CA",
"postal_code": "95655",
"telephone_number": "916-366-5431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "DELAND",
"middle_name": "R",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2009-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NV",
"license": "PY0469",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "KY",
"license": "961",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mather, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.