Jennifer Petersen, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

089122 Issued in NY

Practice address

442 5TH Ave # 1033
New York, NY 10018-2794

Phone

(203) 364-4731

NPI assigned

Mar 29, 2023

Sex

Female

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

Locations

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.

• Matthew Ryan, LCSW, PLLC

  • Clinical Social Worker
  • New York, NY
  • NPI 1780313015
  NPD

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

{
    "created_epoch": "1680048000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1680048000000",
    "number": "1851095293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "913 KEN ST",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787585117",
            "telephone_number": "281-772-2054"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "442 5TH AVE # 1033",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100182794",
            "telephone_number": "203-364-4731"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "913 Ken St",
            "address_purpose": "LOCATION",
            "city": "Austin",
            "state": "TX",
            "postal_code": "787585117",
            "country_code": "US",
            "telephone_number": "281-772-2054",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "JENNIFER",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-03-29",
        "last_updated": "2023-03-29",
        "certification_date": "2023-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "089122",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Rae Petersen, PT, DPT, CSCS
• Alixandra Lin Petersen, DPT
• Bert Petersen, MD
• Brian A Petersen, PSY.D.
• Bruce E Petersen, MD
• Kaya Yalcin Petersen, MD
• Paige Ashley Petersen
• Brian Thomas Peterson, RN, LP
• Briana Mary Peterson, OTR
• Cassie Maude Peterson, LCSW

• Social Worker in New York, NY
• Providers in New York, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2023; 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.