Jeannine Marie Petti, LSW, LCDCIII

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

121142 Issued in OH

Practice address

9083 Mentor Ave
Mentor, OH 44060-6462

Phone

(440) 255-0678

Fax

(440) 255-6348

NPI assigned

Jul 20, 2012

Last updated

Mar 25, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

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": "1342742400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395705600000",
    "number": "1215282744",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9083 MENTOR AVE",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606462",
            "telephone_number": "440-255-0678",
            "fax_number": "440-255-6348"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9083 MENTOR AVE",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440606462",
            "telephone_number": "440-255-0678",
            "fax_number": "440-255-6348"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTI",
        "first_name": "JEANNINE",
        "middle_name": "MARIE",
        "credential": "LSW, LCDCIII",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-07-20",
        "last_updated": "2014-03-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "OH",
            "license": "121142",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "OH",
            "license": "0600839",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael C Peterson, PA-C
• Nicole E Petgrave, NURSE PRACTITIONER
• Kim Petro
• Katherine J Petrochic, LPCC
• Natasha L. Petrow, RN
• Jocelyn Rose Pettitt, O.D.
• Tina Marie Phelps, RN
• Bryan King Philip, D.D.S.
• Lovette Phillips, DO
• Shelby Phillips

• Addiction (Substance Use Disorder) Counselor in Mentor, OH
• Providers in Mentor, OH by specialty
• Addiction (Substance Use Disorder) Counselor in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2014; 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.