Bobbi Petranchuk
Organization Active NPI Clinical Social Worker · Fort Drum, NY
NPI 1083356489 · NPPES record last updated Sep 23, 2024
Key facts
- NPI
- 1083356489
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Social Worker 1041C0700X
- Legal business name
- BOBBI PETRANCHUK
- Practice address
- 11050 Mt Belvedere Blvd RM 1113
Fort Drum, NY 13602-2603 - Phone
- (315) 772-2151
- NPI assigned
- Apr 7, 2022
- Organization subpart
- No
Authorized official
- Name
- Bobbi Petranchuk, LCSW-R
- Title
- Social Worker
- Phone
- (315) 772-2151
Practitioners 1
-
Jennifer Nycole Lively-Pagliuca, LCSW, CADC
National Provider Directory
Locations
11050 Mount Belvedere Blvd
Rm 1113
Fort Drum, NY 13602
Phone (315) 772-2151
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor |
101YM0800X | |||
| Social Worker |
104100000X | |||
| Clinical Social Worker |
1041C0700X | Yes | ||
| Adult Mental Health Clinic/Center | 261QM0850X |
Addresses
Primary practice location
11050 Mt Belvedere Blvd RM 1113
Fort Drum, NY 13602-2603
Mailing address
11050 Mt Belvedere Blvd RM 1113
Fort Drum, NY 13602-2603
Phone (315) 772-2151
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00354316 | Medicaid | NY |
Other names
- US Army Medical Department
Other providers in Fort Drum, NY
- Mary Bice
- Randall Alan Bischoff
- Kabita Bista
- Robert Garfield Blackstock
- Richard C. Blunden
- Heidi L Boerman
- Laura Marie Boff
- Jillisa Boller
- Justine Noel Bolten
- Kyle Bolton
All providers in Fort Drum, NY · Clinical Social Worker in New York
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.