Kirsten E Petersen, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

021715 Issued in NY

Practice address

2389 Babylon St
Wantagh, NY 11793-4501

Phone

(917) 991-1042

NPI assigned

Mar 4, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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 and National Provider Directory roles.

• Dr. Kirsten E. Petersen Psychological Services, PLLC

  dba Kirsten E Petersen, PhD

  • Clinical Psychologist
  • Wantagh, NY
  • NPI 1366067258
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602201600000",
    "number": "1831581594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2389 BABYLON ST",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117934501",
            "telephone_number": "917-991-1042"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2389 BABYLON ST",
            "city": "WANTAGH",
            "state": "NY",
            "postal_code": "117934501",
            "telephone_number": "917-991-1042"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1745 Broadway Fl 17",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100194642",
            "country_code": "US",
            "telephone_number": "212-851-8102",
            "fax_number": "212-537-0102",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3512 Quentin Rd",
            "address_purpose": "LOCATION",
            "city": "Brooklyn",
            "state": "NY",
            "postal_code": "112344244",
            "country_code": "US",
            "telephone_number": "800-275-3243",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KIRSTEN",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-04",
        "last_updated": "2020-10-09",
        "certification_date": "2020-10-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "021715",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NY",
            "license": "P95464",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beth Nicole Pergament, MSED
• Mark H Perlman, PH.D.
• Kristin Marie Perricelli, DPT
• Jeanette Perucca, M.S., CCC-SLP
• Jessica Lynn Peters, LPN
• Sharon L. Petito, L.AC., LMT
• Pamela Susan Pfefer
• Jaymie Phillips, M.S. CCC-SLP
• Jian Pi
• Rachell Pierre-Louis, PSY.D, NCSP

• Clinical Psychologist in Wantagh, NY
• Providers in Wantagh, NY by specialty
• Clinical Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.