Active NPI
Kristin Petitti, LCSW
- Clinical Social Worker
- St Charles, IL
National Provider Identifier
1326549718
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- Practice address
- 111 E Main St
St Charles, IL 60174-1948 - Phone
- (630) 587-3777
- NPI assigned
- Feb 22, 2018
- Last updated
- Feb 22, 2018
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | NU | Primary |
Addresses
Primary practice location
111 E Main St
St Charles, IL 60174-1948
Mailing address
6594 Tealwood Dr
Lisle, IL 60532-3276
Phone (630) 205-3220
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519257600000",
"number": "1326549718",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6594 TEALWOOD DR",
"city": "LISLE",
"state": "IL",
"postal_code": "605323276",
"telephone_number": "630-205-3220"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "111 E MAIN ST",
"city": "ST CHARLES",
"state": "IL",
"postal_code": "601741948",
"telephone_number": "630-587-3777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETITTI",
"first_name": "KRISTIN",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-02-22",
"last_updated": "2018-02-22",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in St Charles, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.