Jodi Sandra Peterson, LIC PROF COUNSELOR

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

001529 Issued in CT

Practice address

47 Town St
Norwich, CT 06360-2323

Phone

(860) 892-7042

Fax

(860) 892-7043

NPI assigned

Oct 17, 2007

Last updated

Nov 15, 2019By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Jodi Sandra Keyes Former name

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• United Community and Family Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Norwich, CT
  • NPI 1467482539
  Medicare reassignment NPD

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

{
    "created_epoch": "1192579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1573776000000",
    "number": "1851580658",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "47 TOWN ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602323",
            "telephone_number": "860-892-7042",
            "fax_number": "860-444-8776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "47 TOWN ST",
            "city": "NORWICH",
            "state": "CT",
            "postal_code": "063602323",
            "telephone_number": "860-892-7042",
            "fax_number": "860-892-7043"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JODI",
        "middle_name": "SANDRA",
        "name_prefix": "Mrs.",
        "credential": "LIC PROF COUNSELOR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-10-17",
        "last_updated": "2019-11-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "001529",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JODI",
            "last_name": "KEYES",
            "middle_name": "SANDRA",
            "prefix": "MS.",
            "credential": "LIC PROF COUNSELOR",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• David Allen Percival, D.M.D.
• Kelsey Lynn Perez
• Amanda Marie Pernal
• Perspective Counseling Services LLC
• Jacob Edward Peterson, MD, MBA
• Michael William Petrides, M.S.(R), ABD, LPC
• Demetrios Petropoulos, DMD
• Sandra Fortier Philips, LCSW
• Colleen Ellen Phillips-White, L.C.S.W.
• Sarah Piekarczyk

• Professional Counselor in Norwich, CT
• Providers in Norwich, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 15, 2019; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.