DR. CAROLYN ALISA PETERSON PHD
NPI 1386403863
Psychologist in Portland, OR

Active since March 18, 2024Opted out of Medicare · through Aug 5, 2028
4039 N MISSISSIPPI AVE STE 307, PORTLAND, OR 97227(971) 402-9705 Get Directions Write a Review

NPPES record last updated: January 25, 2025. Verified against the NPPES registry weekly; last sync: October 25, 2026.

About Dr. Carolyn Alisa Peterson Phd NPPES

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

DR. CAROLYN ALISA PETERSON PHD (NPI 1386403863) is an individual psychologist in Portland, Oregon, licensed in Oregon (3197) and active in the NPI registry since March 2024. She has opted out of Medicare through August 5, 2028.

NPPES Registry Identity

NPI1386403863
Entity TypeIndividualFemale
Primary Taxonomy103T00000X
Provider Legal NameDR. CAROLYN ALISA PETERSONCredential: PHD
Location Address4039 N MISSISSIPPI AVE STE 307Portland, OR 97227-1477
Mailing Address4039 N Mississippi Ave Ste 307Portland, OR 97227-1477 · (971) 402-9705
Sole ProprietorNo
Enumeration DateMarch 18, 2024
Last NPPES UpdateJanuary 25, 2025
NPPES CertifiedJanuary 25, 2025
✔ NPI 1386403863 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License✔ Licensed in OR · 3197
Definition
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.
4039 N MISSISSIPPI AVE STE 307, Portland, OR 97227

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

ⓘ

Opted out of Medicare

Dr. Carolyn Alisa Peterson Phd has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from August 5, 2024 through August 5, 2028.

Opt-Out Effective DateAugust 5, 2024
Opt-Out In Effect ThroughAugust 5, 2028Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 2

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

Clinic/Center (Adult Mental Health)
4039 N MISSISSIPPI AVE STE 307
PORTLAND, OR 97227
Nurse Practitioner (Psychiatric/Mental Health)
4039 N MISSISSIPPI AVE STE 307
PORTLAND, OR 97227

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 Carolyn Peterson's NPI number?

The NPI number for Carolyn Peterson is 1386403863. It was assigned to this individual provider in the NPPES registry on March 18, 2024.

Where is Carolyn Peterson located?

Carolyn Peterson practices at 4039 N Mississippi Ave Ste 307, Portland, OR 97227. The listed phone number is (971) 402-9705.

What is Carolyn Peterson's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Carolyn Peterson enrolled in Medicare?

No. Carolyn Peterson has opted out of Medicare through August 5, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

What insurance does Carolyn Peterson accept?

Health plans from PacificSource Health Plans list Carolyn Peterson as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Carolyn Peterson was last updated on January 25, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 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.