Shanice Nicole Peterson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

134858 Issued in CA

Practice address

1620 5TH Ave Ste 800
San Diego, CA 92101-2792

Phone

(619) 391-9665

NPI assigned

Nov 11, 2019

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1573430400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1771718400000",
    "number": "1861037145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13087 OLYMPUS CIR UNIT 1",
            "city": "POWAY",
            "state": "CA",
            "postal_code": "920644677",
            "telephone_number": "940-642-4712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 5TH AVE STE 800",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921012792",
            "telephone_number": "619-391-9665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "SHANICE",
        "middle_name": "NICOLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-11-11",
        "last_updated": "2026-02-22",
        "certification_date": "2026-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "DC",
            "license": "LG50082715",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "134858",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ryan Lee Peterson, DPT
• Sally Peterson, LCSW
• Sandra Peterson
• Sara Mae Peterson, MT(ASCP)
• Selena E. Peterson
• Sharon E Peterson
• Sydney Peterson
• Tara Jean Peterson, PSYD
• Timothy J. Peterson, MD
• Todd Bailey Peterson, M.D.

• Clinical Social Worker in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2026; 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.