Dr Polly Wietzke Peterson, PHD in Orange Park, FL - Medicare Psychologist Provider

Dr Polly Wietzke Peterson, PHD is a medicare enrolled "Psychologist - School" provider in Orange Park, Florida. Her current practice location is 1543 Kingsley Ave Ste 14, Orange Park, Florida. You can reach out to her office (for appointments etc.) via phone at (904) 742-8164.

Dr Polly Wietzke Peterson is licensed to practice in Florida (license number SS495) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1902929698.

Contact Information

	Dr Polly Wietzke Peterson, PHD
	1543 Kingsley Ave Ste 14, Orange Park, FL 32073-4570
	(904) 742-8164
	(904) 217-7222

Map and Direction

Healthcare Provider's Profile

Full Name	Dr Polly Wietzke Peterson
Gender	Female
Speciality	Psychologist - School
Location	1543 Kingsley Ave Ste 14, Orange Park, Florida
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1902929698
Provider Enumeration Date: 04/09/2007
Last Update Date: 03/12/2021

Medicare PECOS Information:

PECOS PAC ID: 5799107017
Enrollment ID: I20200615002521

Medical Identifiers

Medical identifiers for Dr Polly Wietzke Peterson such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1902929698	NPI	-	NPPES
Z0537	Other	FL	BLUE CROSS BLUE SHIELD FL
346340500	Other	FL	US DEPARTMENT OF LABOR
Z8341	Other	FL	BLUE CROSS BLUE SHIELD FL

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
103TS0200X	Psychologist - School	SS495 (Florida)	Primary

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Polly Wietzke Peterson is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Dr Polly Wietzke Peterson, PHD 2465 Us Highway 1 S Unit 154, St Augustine, FL 32086-6076 Ph: (904) 742-8235	Dr Polly Wietzke Peterson, PHD 1543 Kingsley Ave Ste 14, Orange Park, FL 32073-4570 Ph: (904) 742-8164

Reviews and Comments

Psychologist in Orange Park, FL

Minor Chamblin, PH.D Psychologist Medicare: Not Enrolled in Medicare Practice Location: 1543 Kingsley Ave, Suite 18a, Orange Park, FL 32073 Phone: 904-269-3324 Fax: 904-264-2302
Mrs. Jenny Gamble, SSP Psychologist Medicare: Not Enrolled in Medicare Practice Location: 33 Knight Boxx Rd # 2, Orange Park, FL 32065 Phone: 904-385-9310
Ruth J Keili, Psychologist Medicare: Not Enrolled in Medicare Practice Location: 3562 Old Village Dr, Orange Park, FL 32065 Phone: 757-812-3776
Dr. Vonda Elizabeth Staten, PSYD Psychologist Medicare: Not Enrolled in Medicare Practice Location: 1050 Prairie Dunes Ct, Orange Park, FL 32065 Phone: 904-708-7754
Carole J Crane, PH.D., PA Psychologist Medicare: Accepting Medicare Assignments Practice Location: 1680 Smith St, Suite 1, Orange Park, FL 32073 Phone: 904-264-7099
Dr. Janet Allison Anguas-keiter, PSY.D. Psychologist Medicare: Not Enrolled in Medicare Practice Location: 165 Wells Rd Ste 303, Orange Park, FL 32073 Phone: 904-264-8311
Blake Bazel, PHD Psychologist Medicare: Medicare Enrolled Practice Location: 1677 Wells Rd, Suite A, Orange Park, FL 32073 Phone: 904-272-0043

Dr Polly Wietzke Peterson, PHD - Medicare Psychologist in Orange Park, FL