DR. MARY PETERSON PH.D.
NPI 1720135163
Psychologist - Clinical in Newberg, OR

Q: What is Mary Peterson's NPI number?

The NPI number for Mary Peterson is 1720135163. It was assigned to this individual provider in the NPPES registry on January 5, 2007.

Q: What is Mary Peterson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Q: Is Mary Peterson enrolled in Medicare?

No. Mary Peterson has opted out of Medicare through February 8, 2027. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out.

Q: When was this NPI record last updated?

The NPPES record for Mary Peterson was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years 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.

Active since January 05, 2007Opted out of Medicare · through Feb 8, 2027

414 N MERIDIAN ST, BOX 6275, NEWBERG, OR 97132(503) 554-2377 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Dr. Mary Peterson Ph.d. NPPES

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

DR. MARY PETERSON PH.D. (NPI 1720135163) is an individual clinical provider in Newberg, Oregon, licensed in Oregon (1671) and active in the NPI registry since January 2007. She has opted out of Medicare through February 8, 2027.

NPPES Registry Identity

NPI1720135163

Entity TypeIndividualFemale

Primary Taxonomy103TC0700X

Provider Legal NameDR. MARY PETERSONCredential: PH.D.

Location Address414 N MERIDIAN ST, BOX 6275Newberg, OR 97132-2697

Mailing Address212 Hilltop DrNewberg, OR 97132-9027 · (503) 538-2831

Phone(503) 554-2377

Sole ProprietorYes

Enumeration DateJanuary 5, 2007

Last NPPES UpdateJuly 8, 2007

✔ NPI 1720135163 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers

Taxonomy Code103TC0700X

License✔ Licensed in OR · 1671

Definition

A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.

414 N MERIDIAN ST, Newberg, OR 97132

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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. Mary Peterson Ph.d. 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 February 8, 2023 through February 8, 2027.

Opt-Out Effective DateFebruary 8, 2023

Opt-Out In Effect ThroughFebruary 8, 2027Opt-out affidavits renew automatically every two years unless cancelled

Other Providers at the Same Location NPPES 20

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

BENJAMIN LUKE SHANNON

Counselor (Mental Health)