DR. JOHN ANTHONY PETERSEN (NPI# 1851491526) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851491526 |
| Entity Type | Individual |
| Full Name | DR. JOHN ANTHONY PETERSEN |
| Credential | PSY.D. |
| Practice Address |
922 E Wayne St # 205 South Bend IN 46617-3024 |
| Mailing Address |
208 E Angela Blvd South Bend IN 46617-1202 |
| Practice Telephone | 5742808199 |
| Mailing Telephone | 5742887919 |
| Mailing Fax Number | 5742808199 |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2018-12-01 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103T00000X | Psychologist | 20041594A | IN | Behavioral Health & Social Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 200347860A | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 115 S Saint Peter St, South Bend, IN 466172912 | 5742808199 | 5742808199 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962646224 | John Thomas Petersen | Registered Nurse | 1901 Medi Park Dr Ste 2051, Amarillo, TX 79106-2169 | 2009-04-29 |
| 1497973630 | John Robert Petersen | Chiropractor | 2216 County Road D W, Saint Paul, MN 55112-7500 | 2007-04-23 |
| 1720110737 | John William Petersen | Chiropractor | 12000 Elm Creek Blvd N Ste L70, Maple Grove, MN 55369-7167 | 2007-03-12 |
| 1790786895 | John Peter Petersen | Radiology | 3555 10th Court, Indian River Regional Cancer Center, Irmc, Vero Beach, FL 32960-4862 | 2005-08-10 |
| 1508422411 | John Robert Petersen | Dentist | 4555 Erin Dr, Eagan, MN 55122-3398 | 2019-05-15 |
| 1619361805 | John Devin Petersen | Pediatrics | 757 Westwood Plz, B711 Rrumc, Los Angeles, CA 90095-7419 | 2015-03-25 |
| 1841587854 | John Roger Petersen | Pathology | 301 University Blvd, Galveston, TX 77555-0551 | 2011-06-29 |
| 1114167434 | John Seigfred Petersen | Dentist | 415 Central Ave, Whitefish, MT 59937-2770 | 2009-02-26 |
| 1588868939 | John William Petersen | Internal Medicine | 1600 Sw Archer Rd, Gainesville, FL 32610-3003 | 2007-06-11 |
| 1164580429 | John J Petersen | Physician Assistant | 520 Medical Center Dr, Suite 201, Medford, OR 97504-4334 | 2006-12-05 |
| Street Address |
922 E WAYNE ST # 205 |
| City | SOUTH BEND |
| State | IN |
| Zip Code | 46617-3024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740731116 | Jack Mcintyre Kimmell | Specialist/Technologist | 1526 East Lasalle, South Bend, IN 46617 | 2016-10-20 |
| 1023429115 | Morning View Assisted Living LLC | Assisted Living Facility | 475 N. Niles Avenue, South Bend, IN 46617 | 2014-05-12 |
| 1265861231 | Rebecca Busenbark | Physical Therapist | 401 E Colfax Ave Ste 102, South Bend, IN 46617 | 2013-11-11 |
| 1962709071 | Doreen Danice Huddleston | Social Worker | 928 East Wayne St, Suit C, South Bend, IN 46617 | 2011-02-25 |
| 1487981734 | Mary Cecilia Roemer | Marriage & Family Therapist | 616 E. Colfax Ave, South Bend, IN 46617 | 2009-11-06 |
| 1225264054 | Sridhar Meda | Dentist | 1005 East Lasalle Ave, South Bend, IN 46617 | 2009-06-08 |
| 1063673531 | Madeline Christina Watkins | Counselor | 616 E Colfax, South Bend, IN 46617 | 2008-06-18 |
| 1437366481 | Michael Reed Johns | Dentist | 103 South Eddy Street, South Bend, IN 46617 | 2007-05-17 |
| 1194937680 | Sarah Elizabeth Redman | Specialist/Technologist | 53880 Carmichael Dr., South Bend, IN 46617 | 2007-05-04 |
| 1124241211 | Trixy Franke | Family Medicine | 837 E. Cedar St., Ste 100, South Bend, IN 46617 | 2007-04-10 |
| Find all providers in zip 46617 | ||||
| Taxonomy Code | 103T00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Psychologist |
| A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. |
| Notes: Source: American Psychological Association [1/1/2007: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649580911 | Daniel Scott Debrule | Psychologist | 211 W. Washington Street, Suite 2311, South Bend, IN 46601 | 2010-10-20 |
| 1144498353 | Academic Solutions of Michiana, Inc | Psychologist | 2012 Ironwood Circle, South Bend, IN 46635-1888 | 2008-02-11 |
| 1841308756 | Joyce Block | Psychologist | 300 North Michigan St #208, South Bend, IN 46601 | 2006-08-29 |
| 1982632329 | Jeffrey T Feathergill | Psychologist | 211 W Washington St Ste 2311, South Bend, IN 46601-1708 | 2006-06-28 |
| 1851860878 | Afc Psychological Services, LLC | Psychologist | 1251 N Eddy St Ste 200, South Bend, IN 46617-1478 | 2018-11-20 |
| 1275083768 | Heidi Jo Krug | Psychologist | 2955 Mckinley Ave, Suite C, South Bend, IN 46615-2733 | 2016-10-07 |
| 1295181154 | James Fenstermacher | Psychologist | 112 W Jefferson Blvd, Ste 600, South Bend, IN 46601-1923 | 2016-05-10 |
| 1598145484 | William Bruinsma | Psychologist | 1000 S Michigan St, South Bend, IN 46601-3426 | 2015-06-04 |
| 1952794570 | Matthew Jackson | Psychologist | 714 N Michigan St, South Bend, IN 46601-1035 | 2015-03-06 |
| 1790199529 | Megan Harrity | Psychologist | 919 E Jefferson Blvd, Suite 402, South Bend, IN 46617-3112 | 2014-06-19 |
| Find all providers in SOUTH BEND | ||||
| City | SOUTH BEND |
| Zip Code | 46617 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.