Richard Ross Petty, LCSW - R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

075916 Issued in NY

Practice address

1081 Northside Shopping Ctr
Gorman Foundation Office Suite
Oneida, NY 13421-4901

Phone

(315) 363-5274

Fax

(315) 363-4925

NPI assigned

Mar 14, 2013

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1614729600000",
    "number": "1033450119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1081 NORTHSIDE SHOPPING CTR",
            "address_2": "GORMAN FOUNDATION OFFICE SUITE",
            "city": "ONEIDA",
            "state": "NY",
            "postal_code": "134214901",
            "telephone_number": "315-363-5274",
            "fax_number": "315-363-4925"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1081 NORTHSIDE SHOPPING CTR",
            "address_2": "GORMAN FOUNDATION OFFICE SUITE",
            "city": "ONEIDA",
            "state": "NY",
            "postal_code": "134214901",
            "telephone_number": "315-363-5274",
            "fax_number": "315-363-4925"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTY",
        "first_name": "RICHARD",
        "middle_name": "ROSS",
        "credential": "LCSW - R",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-03-14",
        "last_updated": "2021-03-03",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "075916",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jona Patalino
• Melissa Ann Paul, LPN
• Eileen Marie Pecan, LPN
• Tanya Peterson
• Tyler Peterson, DPT, PT
• Shirley A Peyton, N.P.
• Richard Phelps
• Wanda Phelps, LPN
• Shannon Marie Phillips, FNP
• Joseph John Pierz, MD

• Clinical Social Worker in Oneida, NY
• Providers in Oneida, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.