Shirley Marie Petersen, LCSW LMHP LADC is a
Social Worker - Clinical based in Pine Ridge, South Dakota. Shirley Marie Petersen is licensed to practice in Nebraska (license number 1043) and her current practice location is
Highway 18, Pine Ridge Hospital, Pine Ridge, South Dakota. She can be reached at her office (for appointments etc.) via phone at
(605) 867-3100.
NPI number for Shirley Marie Petersen is 1740356336 and her current mailing address is 917 N Spruce St, Gordon, Nebraska. She
does not participate in medicare program and thus does not accept medicare assignments. Her NPI Number is 1740356336.
Healthcare Provider's Profile
| Full Name | Shirley Marie Petersen |
|---|
| Gender | Female |
|---|
| Speciality | Social Worker - Clinical |
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| Location | Highway 18, Pine Ridge, South Dakota |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. She may not accept medicare assignment. |
|---|
NPI Data:
- NPI Number: 1740356336
- Provider Enumeration Date: 11/27/2006
- Last Update Date: 06/25/2012
Medical Identifiers
Medical identifiers for Shirley Marie Petersen such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1740356336 | NPI | - | NPPES |
| 10025224900 | Medicaid | NE | |
| 82235 | Other | NE | BCBS |
| 47037661202 | Medicaid | NE | |
| 10025315600 | Medicaid | NE | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | P386 (Nebraska) | Secondary |
| 101YM0800X | Counselor - Mental Health | LMHP (Nebraska) | Secondary |
| 1041C0700X | Social Worker - Clinical | 1043 (Nebraska) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shirley Marie Petersen is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Shirley Marie Petersen, LCSW LMHP LADC
917 N Spruce St,
Gordon, NE 69343-1116
Ph: (308) 282-0180 | Shirley Marie Petersen, LCSW LMHP LADC
Highway 18, Pine Ridge Hospital,
Pine Ridge, SD 57770
Ph: (605) 867-3100 |
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