1. Home
  2. Directory
  3. New Jersey
  4. Somerdale
  5. Counselor
  6. NPI Profile

MR. THEODORE PETERSON III LPC, NCC
NPI 1124711973
Counselor - Professional in Somerdale, NJ

Active since May 30, 2023
111 GLENWOOD AVE, SOMERDALE, NJ 08083(201) 774-3774 Get Directions Write a Review

NPPES record last updated: May 29, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: May 29, 2026, May 30, 2023 (2 updates tracked since 2023).

About Mr. Theodore Peterson Iii Lpc, Ncc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. THEODORE PETERSON III LPC, NCC (NPI 1124711973) is an individual professional provider in Somerdale, New Jersey, licensed in New Jersey (37PC00955700) and active in the NPI registry since May 2023.

NPPES Registry Identity

NPI1124711973
Entity TypeIndividualMale
Primary Taxonomy101YP2500X
Provider Legal NameMR. THEODORE PETERSON IIICredential: LPC, NCC
Location Address111 GLENWOOD AVESomerdale, NJ 08083-1709
Mailing Address111 Glenwood AveSomerdale, NJ 08083-1709 · (201) 774-3774
Phone(201) 774-3774
Sole ProprietorYes
Enumeration DateMay 30, 2023
Last NPPES UpdateMay 29, 20262 updates tracked since enumeration
NPPES CertifiedMay 29, 2026
✔ NPI 1124711973 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · ProfessionalBehavioral Health & Social Service Providers
Taxonomy Code101YP2500X
Licenses✔ Licensed in NJ · 37PC00955700✔ Licensed in PA · PC020455
111 GLENWOOD AVE, Somerdale, NJ 08083
Open in Google Maps ↗

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CLAUDIA M PETERSON LCSW
Social Worker (Clinical)
111 GLENWOOD AVE
SOMERDALE, NJ 08083
Camden County (908) 764-0352

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Theodore Peterson's NPI number?

The NPI number for Theodore Peterson is 1124711973. It was assigned to this individual provider in the NPPES registry on May 30, 2023.

Where is Theodore Peterson located?

Theodore Peterson practices at 111 Glenwood Ave, Somerdale, NJ 08083. The listed phone number is (201) 774-3774.

What is Theodore Peterson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Professional, with taxonomy code 101YP2500X.

When was this NPI record last updated?

The NPPES record for Theodore Peterson was last updated on May 29, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.