Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
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Mr. Gordon Wayne Petersen, MSW, LICSW

Individual provider Clinical Social Worker · NPI 1487746244

Mr. Gordon Wayne Petersen, MSW, LICSW is a Clinical Social Worker in Burlington, Vermont. Qualified in 1981, 45 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Vermont.

Years since qualifying
45
Licensed in
VT
In the registry since
2006
What do these letters mean?
MSW — Master of Social Work
The graduate degree in social work.
LICSW — Licensed Independent Clinical Social Worker
The title some states use for an independently practising clinical social worker.

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Practice location Address checks out

166 Battery St
Burlington, VT 05401-5283
Phone: (802) 862-3373
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence 089-0000142 (VT)

Record details

NPI number1487746244
Entity typeIndividual (Type 1)
GenderMale
Credentials MSW , LICSW
Sole proprietorYes
NPI enumeratedSeptember 29, 2006
Last updated in NPPESJuly 8, 2007

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 1981 (45 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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