Steven Mark Peterson, LCSW #23821

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCSW#23821 Issued in CA

Practice address

11875 Dublin Blvd
Suite D274
Dublin, CA 94568

Phone

(925) 819-6775

NPI assigned

May 7, 2009

Last updated

Oct 12, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1241654400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1350000000000",
    "number": "1578797437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11875 DUBLIN BLVD",
            "address_2": "SUITE D274",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "94568",
            "telephone_number": "925-819-6775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11875 DUBLIN BLVD",
            "address_2": "SUITE D274",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "94568",
            "telephone_number": "925-819-6775"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "STEVEN",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "LCSW #23821",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-05-07",
        "last_updated": "2012-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OR",
            "license": "4309",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCSW#23821",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Personal Edge PT, Inc.
• Katherine Nicole Pesochinskiy
• Rebecca Pessagno
• Geera Peters, MD
• Rebekah Peterson
• Jack Petrin
• Amy Petrovich
• Nancy N Pham-Thomas, MD
• Dominique S Pham, DMD
• Phan Dental Group (Atlantis Orthodontics)

• Clinical Social Worker in Dublin, CA
• Providers in Dublin, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2012; 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.