Individual provider Active NPI

Kyle Peterson, LCSW

  • Clinical Social Worker
  • Madison, WI
National Provider Identifier
1700466117
Registry record updated Feb 18, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
9983-123 Issued in WI
Practice address
440 Science Dr Ste 300
Madison, WI 53711-1064
Phone
(262) 999-3495
NPI assigned
Apr 9, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 18, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Social Worker 104100000X 131900-121 WI
Addiction (Substance Use Disorder) Counselor 101YA0400X 19344-130 WI
Clinical Social Worker 1041C0700X 9983-123 WI Primary

Addresses

Primary practice location

440 Science Dr Ste 300
Madison, WI 53711-1064

Mailing address

4800 N Scottsdale Rd Ste 2500
Scottsdale, AZ 85251-7630

Other practice location 1

1202 Northport Dr
Madison, WI 53704-2020
Phone (608) 921-8289

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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

Enrollment IDStateProvider typePAC IDDetails
I20260227001813 WI Practitioner - Clinical Social Worker 1557842481 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cornerstone Counseling Services IncGroup PAC ID 1456256023, 338 clinicians

Practice addresses (Care Compare)

440 Science Dr
Suite 300
Madison, WI 53711-1064
Phone (608) 236-4460

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
19344-130WIMDAddiction (Substance Use Disorder) Counselor
131900-121WIMDSocial Worker
9983-123WIMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Cornerstone Counseling Services, Inc Addiction (Substance Use Disorder) CurrentSince Jan 18, 2026 Accepting new patients

Locations

4800 N Scottsdale Rd
Ste 2500
Scottsdale, AZ 85251
Phone (253) 346-0392

440 Science Dr
Ste 300
Madison, WI 53711
Phone (608) 620-7028

10850 W Park Pl
Ste 100
Milwaukee, WI 53224
Phone (414) 361-4100

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1617926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771372800000",
    "number": "1700466117",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 N SCOTTSDALE RD STE 2500",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852517630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "440 SCIENCE DR STE 300",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537111064",
            "telephone_number": "262-999-3495"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1202 Northport Dr",
            "address_purpose": "LOCATION",
            "city": "Madison",
            "state": "WI",
            "postal_code": "537042020",
            "country_code": "US",
            "telephone_number": "608-921-8289",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "KYLE",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-09",
        "last_updated": "2026-02-18",
        "certification_date": "2026-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "WI",
            "license": "131900-121",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WI",
            "license": "19344-130",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WI",
            "license": "9983-123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.