Lisa A Peterson, LMHC LCDP LCDCS MAC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MHC00235 Issued in RI

Practice address

110 Elmwood Ave
Providence, RI 02907-2423

Phone

(401) 432-6029

Fax

(401) 300-5656

NPI assigned

Aug 31, 2006

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

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in RI

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

Specialty

Mental Health Counselor

Education

Other, 2002

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Victa LLCGroup PAC ID 0840620894, 6 clinicians

Practice addresses (Care Compare)

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 and National Provider Directory roles.

• Victa LLC

  • Addiction Medicine (Internal Medicine) Physician
  • Providence, RI
  • NPI 1104317007

  Mental Health

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749513600000",
    "number": "1962514869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "110 ELMWOOD AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029072423",
            "telephone_number": "401-432-6029",
            "fax_number": "401-300-5656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 ELMWOOD AVE",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029072423",
            "telephone_number": "401-432-6029",
            "fax_number": "401-300-5656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "LISA",
        "middle_name": "A",
        "credential": "LMHC  LCDP LCDCS MAC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-31",
        "last_updated": "2025-06-10",
        "certification_date": "2025-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "RI",
            "license": "LCDP00129",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "RI",
            "license": "MHC00235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CHIP",
            "identifier": "412210",
            "state": "RI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "29290 8",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "LJ55332",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Peter Loss, Acsw Inc
• Peter S. Margolis, MD, Inc.
• Ruth Claire Peterle-Dzurec, CNM
• Bridget Peterson, OD
• Emily Ann Peterson, PA
• Lois Peterson, REGISTERED DIETITIAN
• Jenna Petitt, DPT
• Jessica Petrangelo
• Kirsten Ann Petrarca, AUD
• Ariana Marie Petrella, CNM

• Mental Health Counselor in Providence, RI
• Providers in Providence, RI by specialty
• Mental Health Counselor in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.