DR. CAROLYN ALISA PETERSON PHD
NPI 1386403863
Psychologist in Portland, OR
NPI Status: Active since March 18, 2024
Contact Information
4039 N MISSISSIPPI AVE STE 307
PORTLAND, OR
ZIP 97227
Phone: (971) 402-9705
- Individual
- Female
- Psychologist
- Opted-Out Medicare
About CAROLYN PETERSON
This page provides the complete NPI Profile along with additional information for Carolyn Peterson, a provider established in Portland, Oregon with a medical specialization in Psychologist. The healthcare provider is registered in the NPI registry with number 1386403863 assigned on March 2024. The practitioner's primary taxonomy code is 103T00000X with license number 3197 (OR). The provider is registered as an individual and her NPI record was last updated January 2025.
- NPI
- 1386403863
- Provider Name
- DR. CAROLYN ALISA PETERSON PHD
- Gender
- Female
- Entity Type
- Individual
- Location Address
- 4039 N MISSISSIPPI AVE STE 307 PORTLAND, OR 97227
- Location Phone
- (971) 402-9705
- Mailing Address
- 4039 N MISSISSIPPI AVE STE 307 PORTLAND, OR 97227
- Mailing Phone
- (971) 402-9705
- Is Sole Proprietor?
- No
- Enumeration Date
- 03-18-2024
- Last Update Date
- 01-25-2025
- Code Navigator
A psychologist like Carolyn Peterson studies cognitive, emotional, social processes and behavior by observing, interpreting, and recording how people relate to one another and to their environments. Psychologists gather information and evaluate behavior through controlled laboratory experiments, psychoanalysis, psychotherapy or through personality, performance, aptitude, or intelligence tests, and use this information when testing theories in their research or when treating patients.
The provider doesn't accept Medicare and has signed an affidavit to be excluded from the Medicare program. If you are a Medicare beneficiary this means a provider can charge whatever they want for services rendered but must follow certain rules to do so. Carolyn Peterson opted out of Medicare effective on 08-05-2024 until 08-05-2026. Opt out periods last for two years and cannot be terminated unless the provider is opting out for the very first time and the affidavit is terminated no later than 90 days after the opt out effective date. Opt-out affidavits might renew automatically renew every two years. The provider opted out of Medicare and cannot order and refer services to other healthcare providers.
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Psychologist
- Taxonomy Code
- 103T00000X
- Type
- Behavioral Health & Social Service Providers
- License No.
- 3197
- License State
- OR
- Taxonomy Description
- 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.
Medicare Participation & PECOS Enrollment Status
What is PECOS?
PECOS is the online Medicare enrollment management system or Provider, Enrollment, Chain and Ownership System. The PECOS system is a database of providers who have registered with CMS as providers or suppliers. PECOS is the primary source of information about verified Medicare professionals. Providers that want to participate in this program need to enroll in PECOS with their NPI number to avoid denied claims.
Opted-Out of Medicare? Yes
Opt-Out Effective Date: 08-05-2024
Opt-Out End Date: 08-05-2026
Eligible to Order and Refer? No
Reviews for DR. CAROLYN ALISA PETERSON PHD
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
1 | 3 | 8 | 6 | 4 | 0 | 3 | 8 | 6 | 3 |
Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
2 | 3 | 16 | 6 | 8 | 0 | 6 | 8 | 12 | |
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
2 + 3 + 1 + 6 + 6 + 8 + 0 + 6 + 8 + 1 + 2 + 24 = 67 | |||||||||
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
70 - 67 = 3 | 3 |
The NPI number 1386403863 is valid because the calculated check digit 3 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following provider is registered at the same or nearby location.
ARUN WELLNESS AND PSYCHOLOGICAL SERVICES, LLC
Clinic/Center
(Adult Mental Health)
4039 N MISSISSIPPI AVE STE 307
PORTLAND, OR
ZIP 97227
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1386403863, enumerated as an "individual" on March 18, 2024.
The provider is located at 4039 N MISSISSIPPI AVE STE 307 PORTLAND, OR 97227 and the phone number is (971) 402-9705.
Psychologist with taxonomy code 103T00000X.