LISA A PETERSON LMHC LCDP LCDCS MAC
NPI 1962514869
Counselor - Mental Health in Providence, RI

Q: What is Lisa Peterson's NPI number?

The NPI number for Lisa Peterson is 1962514869. It was assigned to this individual provider in the NPPES registry on August 31, 2006.

Q: What is Lisa Peterson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Q: When was this NPI record last updated?

The NPPES record for Lisa Peterson was last updated on June 10, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 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.

Active since August 31, 2006PECOS EnrolledAccepts Medicare Assignment

110 ELMWOOD AVE, PROVIDENCE, RI 02907(401) 432-6029(401) 300-5656 Get Directions Write a Review

NPPES record last updated: June 10, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

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About Lisa A Peterson Lmhc Lcdp Lcdcs Mac NPPES

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

LISA A PETERSON LMHC LCDP LCDCS MAC (NPI 1962514869) is an individual mental health provider in Providence, Rhode Island, licensed in Rhode Island (MHC00235) and active in the NPI registry since August 2006. She is enrolled in Medicare PECOS and is a graduate of Other (2002).

NPPES Registry Identity

NPI1962514869

Entity TypeIndividualFemale

Primary Taxonomy101YM0800X

Provider Legal NameLISA A PETERSONCredential: LMHC LCDP LCDCS MAC

Location Address110 ELMWOOD AVEProvidence, RI 02907-2423

Mailing Address110 Elmwood AveProvidence, RI 02907-2423 · (401) 432-6029 · Fax (401) 300-5656

Phone(401) 432-6029

Fax(401) 300-5656

Sole ProprietorNo

Medical School CMSOtherGraduated 2002

Enumeration DateAugust 31, 2006

Last NPPES UpdateJune 10, 2025

NPPES CertifiedJune 10, 2025

✔ NPI 1962514869 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers

Taxonomy Code101YM0800X

License✔ Licensed in RI · MHC00235

Also ListedPsychologist · Addiction (Substance Use Disorder)Taxonomy 103TA0400X · License LCDP00129 (RI)

110 ELMWOOD AVE, Providence, RI 02907

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Other Identifiers 3

Other412210RI · Blue Chip

Other29290 8RI · Blue Cross

MedicaidLJ55332RI

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

Lisa A Peterson Lmhc Lcdp Lcdcs Mac 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 ID3577993526

PECOS Enrollment IDI20240426000159

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.

Other Providers at the Same Location NPPES 16

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

SUSAN H HART M.D.

Internal Medicine (Addiction Medicine)