Active NPI
J. Peterson, PH.D., L.L.C.
- Psychologist
- Shepherdstown, WV
National Provider Identifier
1710043211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 741
- Practice address
- 129 East German Street
Room 210
Shepherdstown, WV 25443-1650 - Phone
- (304) 876-3766
- Fax
- (304) 876-8431
- NPI assigned
- Dec 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
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 | 741 | WV | Primary |
Addresses
Primary practice location
129 East German Street
Room 210
Shepherdstown, WV 25443-1650
Mailing address
PO Box 1650
Shepherdstown, WV 25443-1650
Phone (304) 876-3766
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9480075000 | Medicaid | WV |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1204070400000",
"number": "1710043211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1650",
"city": "SHEPHERDSTOWN",
"state": "WV",
"postal_code": "254431650",
"telephone_number": "304-876-3766",
"fax_number": "304-876-8431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "129 EAST GERMAN STREET",
"address_2": "ROOM 210",
"city": "SHEPHERDSTOWN",
"state": "WV",
"postal_code": "254431650",
"telephone_number": "304-876-3766",
"fax_number": "304-876-8431"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "J.",
"credential": "PH.D., L.L.C.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-29",
"last_updated": "2008-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "WV",
"license": "741",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "9480075000",
"state": "WV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Shepherdstown, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.