| Kirsten E Petersen, Phd | |
|
2389 Babylon St Wantagh NY 11793-4501 | |
| (917) 991-1042 | |
| Not Available |
| Full Name | Kirsten E Petersen, Phd |
|---|---|
| Speciality | Psychologist |
| Location | 2389 Babylon St, Wantagh, New York |
| Authorized Official Name and Position | Kirsten Erin Petersen (OWNER) |
| Authorized Official Contact | 9179911042 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kirsten E Petersen, Phd 2389 Babylon St Wantagh NY 11793-4501 Ph: (917) 991-1042 | Kirsten E Petersen, Phd 2389 Babylon St Wantagh NY 11793-4501 Ph: (917) 991-1042 |
| NPI Number | 1366067258 |
|---|---|
| Provider Enumeration Date | 06/16/2020 |
| Last Update Date | 06/17/2020 |
| Certification Date | 06/17/2020 |
| Medicare PECOS PAC ID | 2769898097 |
|---|---|
| Medicare Enrollment ID | O20210310001903 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366067258 | NPI | - | NPPES |
| 901260 | Other | BEACON HEALTH OPTIONS | |
| V53P52 | Other | NY | EMPIRE BLUECROSS BLUESHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kirsten E Petersen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1831581594 PECOS PAC ID: 4183911233 Enrollment ID: I20160919000063 |
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