DR. RENA PETERSON (PSY.D.) – Psychologist, NPI 1306012919

DR. RENA PETERSON (PSY.D.) is a healthcare provider. based in Lake mary, Florida. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PSY.D.. They hold a License No. PY7702 (FL). The NPI Number for DR. RENA PETERSON (PSY.D.) is 1306012919

Main info

Female
Sole Proprietor
20 Years Of Experience
Accepts Medicare Assignment
Name
DR. RENA PETERSON (PSY.D.)
NPI
1306012919
Phone
(561) 702-9216
Address
466 WOLDUNN CIR
Enumeration Date
3 May 2008
Last Update Date
2 April 2019

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7862690333
Graduation Year
2006 (20 years ago)
PAC ID
7416013321
Group Practice PAC ID
4486182342
Professional Enrollment ID
I20090302000251
Address ID
FL331314330MI201XXBLVD401
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience50
Completeness75
Years active:18State licenses:1Digital endpointsOther names

1,602 CLINICAL PSYCHOLOGIST in FL

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Provider Addresses for DR. RENA PETERSON (PSY.D.)

  • 466, Woldunn Circle, Evansdale, Lake Mary, Seminole County, Florida, 32746, United States

    LAKE MARY, FL 327465914

    Phone: (561) 702-9216

    Type: Mailing

  • Lee Road, Winter Park, Orange County, Florida, 32804, United States

    WINTER PARK, FL 327891870

    Phone: (407) 450-8151

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2009-03-02

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20090302000251IClinical PsychologistFLTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 32746)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 4486182342View full group profile
NameSpecialtyState
Clinical PsychologistCA
Clinical PsychologistMD
Clinical Social WorkerMD
Clinical PsychologistCO
Mental Health CounselorMD
Clinical PsychologistNY
Clinical PsychologistTN
Clinical PsychologistNC
Clinical PsychologistTX
Clinical Social WorkerMD

Reviews

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Frequently asked questions

How do I look up DR. RENA PETERSON (PSY.D.) by NPI?
Use NPI 1306012919 when you need to reference DR. RENA PETERSON (PSY.D.) in forms, claims, or directories.
Is DR. RENA PETERSON (PSY.D.)'s enrollment marked active?
An active flag here means the NPI record is not in a deactivated state.
Does DR. RENA PETERSON (PSY.D.) list a primary specialty?
If you are matching referrals, note Psychologist for DR. RENA PETERSON (PSY.D.). Clinical services aligned with this taxonomy classification.
Does DR. RENA PETERSON (PSY.D.) practice in Florida?
You will see Lake Mary, Florida on file for DR. RENA PETERSON (PSY.D.) alongside any extra practice locations.
Is this NPI for an individual or an organization?
This listing corresponds to an Individual Provider.

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