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LUCAS CEDRIC PETERSEN
NPI 1710869557
Social Worker - Clinical in Boise, ID

Active since July 23, 2025
6177 N OLIVER AVE, BOISE, ID 83714(208) 954-2310 Get Directions Write a Review

NPPES record last updated: July 23, 2025. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Lucas Cedric Petersen NPPES

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

LUCAS CEDRIC PETERSEN (NPI 1710869557) is an individual clinical provider in Boise, Idaho, licensed in Idaho (8911017) and active in the NPI registry since July 2025.

NPPES Registry Identity

NPI1710869557
Entity TypeIndividualMale
Primary Taxonomy1041C0700X
Provider Legal NameLUCAS CEDRIC PETERSEN
Location Address6177 N OLIVER AVEBoise, ID 83714-2070
Mailing Address6177 N Oliver AveBoise, ID 83714-2070 · (208) 954-2310
Phone(208) 954-2310
Sole ProprietorYes
Enumeration DateJuly 23, 2025
NPPES CertifiedJuly 23, 2025
✔ NPI 1710869557 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySocial Worker · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code1041C0700X
License✔ Licensed in ID · 8911017
Definition
A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment (including psychotherapy and counseling), client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.
6177 N OLIVER AVE, Boise, ID 83714
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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 Lucas Petersen's NPI number?

The NPI number for Lucas Petersen is 1710869557. It was assigned to this individual provider in the NPPES registry on July 23, 2025.

Where is Lucas Petersen located?

Lucas Petersen practices at 6177 N Oliver Ave, Boise, ID 83714. The listed phone number is (208) 954-2310.

What is Lucas Petersen's specialty?

The primary specialty registered for this NPI is Social Worker, specializing in Clinical, with taxonomy code 1041C0700X.

When was this NPI record last updated?

The NPPES record for Lucas Petersen was last updated on July 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 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.