Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lucas Cedric Petersen

Individual provider Clinical Social Worker · NPI 1710869557

Lucas Cedric Petersen is a Clinical Social Worker in Boise, Idaho. Practices as a sole proprietor. Licensed in Idaho.

Licensed in
ID
In the registry since
2025

Practice location Address checks out

6177 N Oliver Ave
Boise, ID 83714-2070
Phone: (208) 954-2310
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 8911017 (ID)

Record details

NPI number1710869557
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorYes
NPI enumeratedJuly 23, 2025
Last updated in NPPESJuly 23, 2025
Certification dateJuly 23, 2025

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