Active NPI
Julie Blake Peterson, LCSW
- Social Worker
- Pantego, TX
National Provider Identifier
1942900667
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 28303
- Practice address
- 2810 Peachtree LN
Pantego, TX 76013-3115 - Phone
- (817) 412-9704
- NPI assigned
- Mar 9, 2023
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 28303 | TX | Primary |
Addresses
Primary practice location
2810 Peachtree LN
Pantego, TX 76013-3115
Mailing address
2810 Peachtree LN
Pantego, TX 76013-3115
Phone (817) 412-9704
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28303 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1678320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1784246400000",
"number": "1942900667",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2810 PEACHTREE LN",
"city": "PANTEGO",
"state": "TX",
"postal_code": "760133115",
"telephone_number": "817-412-9704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2810 PEACHTREE LN",
"city": "PANTEGO",
"state": "TX",
"postal_code": "760133115",
"telephone_number": "817-412-9704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETERSON",
"first_name": "JULIE",
"middle_name": "BLAKE",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-09",
"last_updated": "2026-07-17",
"certification_date": "2026-07-17",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TX",
"license": "28303",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pantego, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.