Lisa A Peterson, LMHC LCDP LCDCS MAC is a medicare enrolled "Counselor - Mental Health" provider in Providence, Rhode Island. She graduated from medical school in 2002 and has 24 years of diverse experience with area of expertise as Mental Health Counselor. She is a member of the group practice Victa Llc and her current practice location is
110 Elmwood Ave, Providence, Rhode Island. You can reach out to her office (for appointments etc.) via phone at
(401) 432-6029.
Lisa A Peterson is licensed to practice in Rhode Island (license number MHC00235) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1962514869.
Healthcare Provider's Profile
| Full Name | Lisa A Peterson |
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| Gender | Female |
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| Speciality | Mental Health Counselor |
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| Experience | 24 Years |
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| Location | 110 Elmwood Ave, Providence, Rhode Island |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Lisa A Peterson graduated from medical school in 2002
NPI Data:
- NPI Number: 1962514869
- Provider Enumeration Date: 08/31/2006
- Last Update Date: 06/10/2025
Medicare PECOS Information:
- PECOS PAC ID: 3577993526
- Enrollment ID: I20240426000159
Medical Identifiers
Medical identifiers for Lisa A Peterson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1962514869 | NPI | - | NPPES |
| 412210 | Other | RI | BLUE CHIP |
| 29290 8 | Other | RI | BLUE CROSS |
| LJ55332 | Medicaid | RI | |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 103TA0400X | Psychologist - Addiction (substance Use Disorder) | LCDP00129 (Rhode Island) | Secondary |
| 101YM0800X | Counselor - Mental Health | MHC00235 (Rhode Island) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|
| Victa Llc | 0840620894 | 6 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Lisa A Peterson allows following entities to bill medicare on her behalf.
| Entity Name | Victa Llc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1104317007
PECOS PAC ID: 0840620894
Enrollment ID: O20200415002461 |
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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. Lisa A 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 |
|---|
Lisa A Peterson, LMHC LCDP LCDCS MAC
110 Elmwood Ave,
Providence, RI 02907-2423
Ph: (401) 432-6029 | Lisa A Peterson, LMHC LCDP LCDCS MAC
110 Elmwood Ave,
Providence, RI 02907-2423
Ph: (401) 432-6029 |
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