DR. POLLY WIETZKE PETERSON PH.D.
NPI 1902929698
Psychologist - School in Orange Park, FL

Active since April 09, 2007PECOS EnrolledAccepts Medicare Assignment
1543 KINGSLEY AVE STE 14, ORANGE PARK, FL 32073(904) 742-8164(904) 217-7222 Get Directions Write a Review

NPPES record last updated: March 12, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Mar 12, 2021, Jul 28, 2020, Jun 23, 2020 (3 updates tracked since 2020).

About Dr. Polly Wietzke Peterson Ph.d. NPPES

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

DR. POLLY WIETZKE PETERSON PH.D. (NPI 1902929698) is an individual school provider in Orange Park, Florida, licensed in Florida (SS495) and active in the NPI registry since April 2007. She is enrolled in Medicare PECOS and is a graduate of Other (1973).

NPPES Registry Identity

NPI1902929698
Entity TypeIndividualFemale
Primary Taxonomy103TS0200X
Provider Legal NameDR. POLLY WIETZKE PETERSONCredential: PH.D.
Location Address1543 KINGSLEY AVE STE 14Orange Park, FL 32073-4570
Mailing Address2465 Us Highway 1 S Unit 154St Augustine, FL 32086-6076 · (904) 742-8235 · Fax (904) 217-7222
Fax(904) 217-7222
Sole ProprietorYes
Medical School CMSOtherGraduated 1973
Enumeration DateApril 9, 2007
Last NPPES UpdateMarch 12, 20213 updates tracked since enumeration
NPPES CertifiedDecember 24, 2020
NPI 1902929698 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyPsychologist · SchoolBehavioral Health & Social Service Providers
Taxonomy Code103TS0200X
License Licensed in FL · SS495
Definition

A psychologist whose specialty is concerned with the science and practice of psychology with children, youth, families; learners of all ages; and the schooling process. The basic education and training of school psychologists prepares them to provide a range of psychological diagnosis, assessment, intervention, prevention, health promotion, and program development and evaluation services with a special focus on the developmental processes of children and youth within the context of schools, families and other systems. School psychologists are prepared to intervene at the individual and system level, and develop, implement, and evaluate preventive programs. In these efforts, they conduct ecologically valid assessments and intervene to promote positive learning environments within which children and youth from diverse backgrounds to ensure that all have equal access to effective educational and psychological services that promote healthy development

1543 KINGSLEY AVE STE 14, Orange Park, FL 32073

Other Identifiers 3

OtherZ8341FL · Blue Cross Blue Shield Fl
OtherZ0537FL · Blue Cross Blue Shield Fl
Other346340500FL · Us Department Of Labor

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Dr. Polly Wietzke Peterson Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID5799107017
PECOS Enrollment IDI20200615002521
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 2

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Psychiatric services complicated by communication factor 90785
Psychiatric services complicated by communication factors involve mental health care for individuals who have challenges with communication. This can include language barriers, speech disorders, or cognitive impairments. The process involves tailored strategies to ensure effective communication and appropriate mental health care.
134 services14 patients
Psychotherapy, 1 hour 90837
Psychotherapy is a therapeutic interaction or treatment between a trained professional and a patient. In a 1-hour session, you'll talk about your feelings, thoughts, and behaviors to help identify and manage mental health issues. This process aids in personal growth, healing, and improved well-being.
129 services14 patients

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 Peterson's NPI number?

The NPI number for Polly Peterson is 1902929698. It was assigned to this individual provider in the NPPES registry on April 9, 2007.

Where is Polly Peterson located?

Polly Peterson practices at 1543 Kingsley Ave Ste 14, Orange Park, FL 32073. The listed phone number is (904) 742-8164.

What is Polly Peterson's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in School, with taxonomy code 103TS0200X.

Is Polly Peterson enrolled in Medicare?

Yes. Polly Peterson is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Polly Peterson accept?

Health plans from Oscar Health Maintenance Organization of Florida list Polly 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 Polly Peterson was last updated on March 12, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.