Lisa A Peterson, LMHC LCDP LCDCS MAC is a medicare enrolled "Counselor - Mental Health" provider in Providence, Rhode Island. Her current practice location is
110 Elmwood Ave, Providence, Rhode Island. You can reach out to her office (for appointments etc.) via phone at
(401) 432-6029.
Lisa A Peterson is licensed to practice in Rhode Island (license number MHC00235) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1962514869.
Healthcare Provider's Profile
| Full Name | Lisa A Peterson |
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| Gender | Female |
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| Speciality | Counselor - Mental Health |
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| Location | 110 Elmwood Ave, Providence, Rhode Island |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1962514869
- Provider Enumeration Date: 08/31/2006
- Last Update Date: 06/26/2019
Medicare PECOS Information:
- PECOS PAC ID: 3577993526
- Enrollment ID: I20240426000159
Medical Identifiers
Medical identifiers for Lisa A Peterson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1962514869 | NPI | - | NPPES |
| 412210 | Other | RI | BLUE CHIP |
| 29290 8 | Other | RI | BLUE CROSS |
| LJ55332 | Medicaid | RI | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | LCDP00129 (Rhode Island) | Secondary |
| 101YM0800X | Counselor - Mental Health | MHC00235 (Rhode Island) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Lisa A Peterson allows following entities to bill medicare on her behalf.
| Entity Name | Victa Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1104317007
PECOS PAC ID: 0840620894
Enrollment ID: O20200415002461 |
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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. Lisa A Peterson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Lisa A Peterson, LMHC LCDP LCDCS MAC
110 Elmwood Ave,
Providence, RI 02907-2423
Ph: (401) 432-6029 | Lisa A Peterson, LMHC LCDP LCDCS MAC
110 Elmwood Ave,
Providence, RI 02907-2423
Ph: (401) 432-6029 |
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