Active NPI
Heather Grant Petanovitch, LCSW
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1174698237
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 27095
- Practice address
- 3161 Hawthron Street
San Diego, CA 92104-2360 - Phone
- (858) 752-3025
- NPI assigned
- Nov 22, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 20517 | CA | |
| Clinical Social Worker | 1041C0700X | 27095 | CA | Primary |
Addresses
Primary practice location
3161 Hawthron Street
San Diego, CA 92104-2360
Mailing address
3161 Hawthron Street
San Diego, CA 92104
Phone (858) 752-3025
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 20517 | CA | MD | Mental Health Counselor |
| 27095 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384300800000",
"number": "1174698237",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3161 HAWTHRON STREET",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "92104",
"telephone_number": "858-752-3025"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3161 HAWTHRON STREET",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921042360",
"telephone_number": "858-752-3025"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETANOVITCH",
"first_name": "HEATHER",
"middle_name": "GRANT",
"name_prefix": "Mrs.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-22",
"last_updated": "2013-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "20517",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "27095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 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.