Megan Petach, LCSW, LCADC, CCM

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

44SC05756700 Issued in NJ

Practice address

1 Riverview PLZ
Red Bank, NJ 07701-1864

Phone

(732) 450-2765

NPI assigned

Apr 9, 2020

Sex

Female

Sole proprietor

Yes

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": "1586390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623715200000",
    "number": "1235758335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "89 CENTER AVE",
            "city": "LEONARDO",
            "state": "NJ",
            "postal_code": "077371157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 RIVERVIEW PLZ",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "077011864",
            "telephone_number": "732-450-2765"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "89 Center Ave",
            "address_purpose": "LOCATION",
            "city": "Leonardo",
            "state": "NJ",
            "postal_code": "077371157",
            "country_code": "US",
            "telephone_number": "732-233-1691",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PETACH",
        "first_name": "MEGAN",
        "name_prefix": "Ms.",
        "credential": "LCSW, LCADC, CCM",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-04-09",
        "last_updated": "2021-06-15",
        "certification_date": "2021-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00274200",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05756700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Red Bank, NJ
• Providers in Red Bank, NJ by specialty
• Clinical Social Worker in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.