Lucas Cedric Petersen

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

8911017 Issued in ID

Practice address

6177 N Oliver Ave
Boise, ID 83714-2070

Phone

(208) 954-2310

NPI assigned

Jul 23, 2025

Last updated

Jul 23, 2025By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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

• Petersen Mental Health PLLC

  • Clinical Social Worker
  • Boise, ID
  • NPI 1255247847
  NPD (past) Authorized official

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

{
    "created_epoch": "1753228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753228800000",
    "number": "1710869557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6177 N OLIVER AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837142070",
            "telephone_number": "208-954-2310"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6177 N OLIVER AVE",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837142070",
            "telephone_number": "208-954-2310"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "LUCAS",
        "middle_name": "CEDRIC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-07-23",
        "last_updated": "2025-07-23",
        "certification_date": "2025-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "8911017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kyle Randall Peterman, FNP
• Ester Peters, DO
• Heidi S Peters, NP
• Petersen Mental Health PLLC
• Krista I Petersen, FNP-C
• Nicole Lynne Petersen
• Robert L Petersen, MD
• Sarah Brienne Petersen
• Peterson Family Dentistry
• Peterson Thrive Therapy

• Clinical Social Worker in Boise, ID
• Providers in Boise, ID by specialty
• Clinical Social Worker in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2025; 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.