Jackie Peterson, LICSW, LCSW

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

Practice address

399 Boylston St
Boston, MA 02116-3305

Phone

(617) 336-3246

NPI assigned

Jul 19, 2018

Sex

Female

Sole proprietor

Yes

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)

Enrolled

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

{
    "created_epoch": "1531958400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1932685252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 HARRISON AVE",
            "city": "WALLINGFORD",
            "state": "CT",
            "postal_code": "064925003",
            "telephone_number": "203-350-9565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "399 BOYLSTON ST",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "021163305",
            "telephone_number": "617-336-3246"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "585 Lincoln St",
            "address_purpose": "LOCATION",
            "city": "Worcester",
            "state": "MA",
            "postal_code": "016051906",
            "country_code": "US",
            "telephone_number": "508-831-0045",
            "fax_number": "508-856-7390",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "JACKIE",
        "credential": "LICSW, LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-19",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Clayton Ross Peterson, MD
• Diane Peterson
• Erin Peterson, LICSW
• Hanna Jane Peterson, MD
• Hannah Marie Peterson, NP
• Kimberly Peterson
• Mackenzie Grace Peterson
• Margaret Ride Peterson, PA
• Mariko Sada Peterson, MD/PHD
• Mary Anne L Peterson, PA-C

• Mental Health Counselor in Boston, MA
• Providers in Boston, MA by specialty
• Mental Health Counselor in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.