Kathleen C Petersen, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149014870 Issued in IL

Practice address

591 Columbia Ave
Des Plaines, IL 60016-3062

Phone

(847) 757-5050

NPI assigned

Sep 16, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Kathleen Ann Cavanagh Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1379289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379289600000",
    "number": "1053747576",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "591 COLUMBIA AVE",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600163062",
            "telephone_number": "847-757-5050"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "591 COLUMBIA AVE",
            "city": "DES PLAINES",
            "state": "IL",
            "postal_code": "600163062",
            "telephone_number": "847-757-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "KATHLEEN",
        "middle_name": "C",
        "name_prefix": "Ms.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-16",
        "last_updated": "2013-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149014870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KATHLEEN",
            "last_name": "CAVANAGH",
            "middle_name": "ANN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Nicole Maria Peszko
• Peter E Johnson MD SC
• Peter J Kiefer MD LTD
• Peter M. Durbin, D.D.S., M.S., P.C.
• Lisy Joy Peters, NP
• Djuro Petkovic, M.D.
• Bradley Petrik
• Marcelo Petti
• Jennifer A. Pfaff, LCSW
• Katherine A Pfeiffer, LCPC, LPC

• Clinical Social Worker in Des Plaines, IL
• Providers in Des Plaines, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2013; 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.