Active NPI
Amanda Lynn Petersen, CDCA
- Peer Specialist
- Canton, OH
National Provider Identifier
1679454284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- OCPS.161571
- Practice address
- 624 Market Ave N
Canton, OH 44702-1017 - Phone
- (330) 479-1912
- Fax
- (330) 497-0677
- NPI assigned
- Sep 10, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | OCPS.161571 | OH | Primary |
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | CDCA.193508 | OH |
Addresses
Primary practice location
624 Market Ave N
Canton, OH 44702-1017
Mailing address
624 Market Ave N
Canton, OH 44702-1017
Phone (330) 479-1912
Other practice location 1
1680 Nave Rd SE
Massillon, OH 44646-9604
Phone (330) 830-8740
Other practice location 2
1660 Nave Rd SE
Massillon, OH 44646-9604
Phone (330) 454-6800
Other names 1
- Amanda L Petersen
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 |
|---|---|---|---|
| CDCA.193508 | OH | MD | Addiction (Substance Use Disorder) Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1757462400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1786924800000",
"number": "1679454284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "624 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447021017",
"telephone_number": "330-479-1912",
"fax_number": "330-497-0677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "624 MARKET AVE N",
"city": "CANTON",
"state": "OH",
"postal_code": "447021017",
"telephone_number": "330-479-1912",
"fax_number": "330-497-0677"
}
],
"practiceLocations": [
{
"address_1": "1680 Nave Rd SE",
"address_purpose": "LOCATION",
"city": "Massillon",
"state": "OH",
"postal_code": "446469604",
"country_code": "US",
"telephone_number": "330-830-8740",
"fax_number": "330-830-0912",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1660 Nave Rd SE",
"address_purpose": "LOCATION",
"city": "Massillon",
"state": "OH",
"postal_code": "446469604",
"country_code": "US",
"telephone_number": "330-454-6800",
"fax_number": "330-588-7176",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "PETERSEN",
"first_name": "AMANDA",
"middle_name": "LYNN",
"credential": "CDCA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-09-10",
"last_updated": "2026-08-17",
"certification_date": "2026-08-17",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": "OCPS.161571",
"primary": true
},
{
"code": "101YA0400X",
"taxonomy_group": "",
"desc": "Counselor, Addiction (Substance Use Disorder)",
"state": "OH",
"license": "CDCA.193508",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "AMANDA",
"last_name": "PETERSEN",
"middle_name": "L",
"credential": "PEER SUPPORT",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.