Active NPI
Lisa Petersen, PH.D.
- Psychologist
- Sacramento, CA
National Provider Identifier
1699813923
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 18432
- Practice address
- 601 University Ave
Suite #225
Sacramento, CA 95825-6775 - Phone
- (916) 920-5276
- Fax
- (916) 920-5221
- NPI assigned
- Feb 1, 2007
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 18432 | CA | Primary |
Addresses
Primary practice location
601 University Ave
Suite #225
Sacramento, CA 95825-6775
Mailing address
601 University Ave
Suite #225
Sacramento, CA 95825-6775
Phone (916) 920-5276
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1699813923",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "601 UNIVERSITY AVE",
"address_2": "SUITE #225",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958256775",
"telephone_number": "916-920-5276",
"fax_number": "916-920-5221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 UNIVERSITY AVE",
"address_2": "SUITE #225",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958256775",
"telephone_number": "916-920-5276",
"fax_number": "916-920-5221"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSEN",
"first_name": "LISA",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "18432",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Sacramento, CA
Sources for this page
- 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.