POLLY W. PETERSON, PH.D.
NPI 1427702091
Psychologist in Orange Park, FL

Active since February 11, 2022
1543 KINGSLEY AVE STE 14, ORANGE PARK, FL 32073(904) 742-8235(904) 217-7222 Get Directions Write a Review

NPPES record last updated: February 11, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Polly W. Peterson, Ph.d. NPPES

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

POLLY W. PETERSON, PH.D. (NPI 1427702091) is a healthcare organization registered as a psychologist in Orange Park, Florida and active in the NPI registry since February 2022. The organization lists Polly Wietzke Peterson, Psychologist/owner, as its authorized official.

NPPES Registry Identity

NPI1427702091
Entity TypeOrganization
Primary Taxonomy103T00000X
Legal Business NamePOLLY W. PETERSON, PH.D.
Location Address1543 KINGSLEY AVE STE 14Orange Park, FL 32073-4570
Mailing Address2465 Us Highway 1 S Unit 154Saint Augustine, FL 32086-6076 · (904) 742-8164 · Fax (904) 217-7222
Fax(904) 217-7222
Organization SubpartNo
Authorized OfficialPolly Wietzke PetersonPsychologist/owner · (904) 742-8164
Enumeration DateFebruary 11, 2022
NPPES CertifiedFebruary 11, 2022
NPI 1427702091 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
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.

1543 KINGSLEY AVE STE 14, Orange Park, FL 32073

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Other Providers at the Same Location NPPES 13

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

Psychiatry & Neurology (Psychiatry)
1543 KINGSLEY AVE STE 14
ORANGE PARK, FL 32073
Counselor (Mental Health)
1543 KINGSLEY AVE STE 14
ORANGE PARK, FL 32073
Psychiatry & Neurology (Psychiatry)
1543 KINGSLEY AVE STE 14
ORANGE PARK, FL 32073
Counselor (Mental Health)
1543 KINGSLEY AVE STE 14
ORANGE PARK, FL 32073
Psychiatry & Neurology (Psychiatry)
1543 KINGSLEY AVE STE 14
ORANGE PARK, FL 32073
Counselor (Mental Health)
1543 KINGSLEY AVE STE 14
ORANGE PARK, FL 32073
Psychiatry & Neurology (Psychiatry)
1543 KINGSLEY AVE STE 14
ORANGE PARK, FL 32073
Nurse Practitioner (Psychiatric/Mental Health)
1543 KINGSLEY AVE STE 14
ORANGE PARK, FL 32073

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 Polly W. Peterson, Ph.D.'s NPI number?

The NPI number for Polly W. Peterson, Ph.D. is 1427702091. It was assigned to this organization in the NPPES registry on February 11, 2022.

Where is Polly W. Peterson, Ph.D. located?

Polly W. Peterson, Ph.D. is located at 1543 Kingsley Ave Ste 14, Orange Park, FL 32073. The listed phone number is (904) 742-8235.

What is Polly W. Peterson, Ph.D.'s specialty?

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

When was this NPI record last updated?

The NPPES record for Polly W. Peterson, Ph.D. was last updated on February 11, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.