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Deactivated NPI 1790708725 Deactivated / Inactive NPI Male Practitioner

Dr. Frederick L Peterson , PsyD

Psychologist • Dayton, OH

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Frederick Peterson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date July 25, 2006
NPI Deactivation Date March 06, 2025
Total Practice Duration ~19 Years of Practice (2006 – 2025)

Professional Overview & Biography Verified Profile Summary

Dr. Frederick Peterson, PsyD was a registered Psychologist practicing in Dayton, OH. Throughout an active medical career spanning 19 years, Dr. Peterson provided care at the practice location at 627 S EDWIN C MOSES BLVD until profile deactivation on 2025-03-06.

Practice Location & Contact Primary Location

Practice Address

627 S Edwin C Moses Blvd
Suite K 5th Floor

Dayton, OH 454081461

Telephone 9374241000
Associated Practice Facility / Clinic
🏢 Dvl Vascular Lab Inc Facility NPI 1114919065

Specialty Benchmarks & Practice Insights

Comparative analytics for Psychologist in Dayton, OH

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 27.1 Yrs
State Avg: 26.0 Yrs
Regional Practice Density
65 Specialists

Practicing in Dayton, OH (1639 Statewide)

Telehealth Adoption Rate
3.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Psychologist Primary Specialty

NUCC Taxonomy Code: 103T00000X

State License OH 3738

A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

7 Associated Practitioners
Dr. Amarjeet Birdi , MD

Psychiatry & Neurology - Psychiatry

NPI 1023046190

Doctor of Medicine (M.D.)

Shawn Breeding , PA-C

Physician Assistant

NPI 1073885216

Physician Assistant (Certified)

NPI 1083724108

Doctor of Philosophy (Ph.D.)

Dr. Joseph Trevino , MD

Psychiatry & Neurology - Psychiatry

NPI 1326118845

Doctor of Medicine (M.D.)

Beverly Brown , LISW

Social Worker - Clinical

NPI 1629270855

Licensed Independent Social Worker

Dr. Amita Patel , MD

Psychiatry & Neurology - Psychiatry

NPI 1649265489

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated March 06, 2025

Record deactivated on March 06, 2025

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 627 S EDWIN C MOSES BLVD, SUITE K 5TH FLOOR, DAYTON, OH 454081461 (Tel: 9374241000)

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Updated Business Mailing Address July 08, 2007

Registered at 1311 E HIGH ST, SPRINGFIELD, OH 455051125

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Provider Name / Credentials Updated July 08, 2007

Recorded as FREDERICK PETERSON, PSY.D

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Psychologist (License #3738 in OH)

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Initial NPI Registration & Enumeration July 25, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1790708725
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: July 25, 2006
Last Update: July 08, 2007
Deactivation Date: March 06, 2025

Mailing Address

1311 E High St

Springfield, OH 455051125

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

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