Active NPI
Jerry Petell, LMSW
- Social Worker
- Albany, NY
National Provider Identifier
1326409350
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 061436-1
- Practice address
- 10 Eliot Ave
Albany, NY 12203-2612 - Phone
- (518) 458-9886
- NPI assigned
- Mar 18, 2016
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 061436-1 | NY | Primary |
Addresses
Primary practice location
10 Eliot Ave
Albany, NY 12203-2612
Mailing address
10 Eliot Ave
Albany, NY 12203-2612
Phone (518) 458-9886
Other names 1
- Jerry Petell
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 |
|---|---|---|---|
| 061436-1 | NY | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458259200000",
"number": "1326409350",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10 ELIOT AVE",
"city": "ALBANY",
"state": "NY",
"postal_code": "122032612",
"telephone_number": "518-458-9886"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10 ELIOT AVE",
"city": "ALBANY",
"state": "NY",
"postal_code": "122032612",
"telephone_number": "518-458-9886"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETELL",
"first_name": "JERRY",
"credential": "LMSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-18",
"last_updated": "2016-03-18",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "NY",
"license": "061436-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "JERRY",
"last_name": "PETELL",
"credential": "LMSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Albany, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.