Robert John Peterson, LICSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

60174553 Issued in WA

Practice address

40647 Lake Rd
Loon Lake, WA 99148-9795

Phone

(509) 939-5515

NPI assigned

Nov 18, 2009

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 2

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 and National Provider Directory roles.

• Moriarty Municipal School

  • Local Education Agency (LEA)
  • Moriarty, NM
  • NPI 1679793160
  NPD (past)

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

{
    "created_epoch": "1258502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699488000000",
    "number": "1922336684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40647 LAKE RD",
            "city": "LOON LAKE",
            "state": "WA",
            "postal_code": "991489795",
            "telephone_number": "099-395-5155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40647 LAKE RD",
            "city": "LOON LAKE",
            "state": "WA",
            "postal_code": "991489795",
            "telephone_number": "509-939-5515"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 Center St",
            "address_purpose": "LOCATION",
            "city": "Moriarty",
            "state": "NM",
            "postal_code": "870352000",
            "country_code": "US",
            "telephone_number": "505-832-5817",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "ROBERT",
        "middle_name": "JOHN",
        "credential": "LICSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-11-18",
        "last_updated": "2023-11-09",
        "certification_date": "2023-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "60174553",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NM",
            "license": "X-06759",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PED LICENSE",
            "identifier": "336712",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "X-06759",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Melinda Cecile Ekholm, ARNP
• Here to Help Homecare, LLC (Enable)
• Brenda Michele Hughbanks, MA 60040625
• Loon Lake School District #183
• New Health Programs Association (NEW Health Loon Lake Medical)
• Reflect Behavioral Health Billing
• Tina Marie Welsh, LPN
• Michelle Woodward, LICSW

• Clinical Social Worker in Loon Lake, WA
• Providers in Loon Lake, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.