Casimir Edward Petkunas III, MSW, LSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

150.106675 Issued in IL

Practice address

323 W Mulberry St
Watseka, IL 60970-1568

Phone

(815) 432-5241

NPI assigned

Mar 13, 2022

Last updated

Jun 9, 2022By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Edgewood Clinical Services, P.C.

  dba LifeStance

  • Psychologist
  • Naperville, IL
  • NPI 1295914646
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1647129600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1654732800000",
    "number": "1396493094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N ELM ST",
            "city": "MOMENCE",
            "state": "IL",
            "postal_code": "609541138",
            "telephone_number": "779-240-2494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "323 W MULBERRY ST",
            "city": "WATSEKA",
            "state": "IL",
            "postal_code": "609701568",
            "telephone_number": "815-432-5241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETKUNAS",
        "first_name": "CASIMIR",
        "middle_name": "EDWARD",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "MSW, LSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-03-13",
        "last_updated": "2022-06-09",
        "certification_date": "2022-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "IL",
            "license": "150.106675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lisa Pearson
• Austin L Pendry
• Petersen Health Care II, Inc (Watseka Rehabilitaion & Health Care Center)
• Petersen Health Operations, LLC (Sugar Creek Care Center)
• Jeffrey W. Petersen, ATC
• Philip Zumwalt,M.D. (Watseka Family Practice)
• Denise Pillot
• Issac G. Plamoottil, M.D.
• Peter Joseph Pollachek, A.P.N.
• Michael T Potter, BA

• Social Worker in Watseka, IL
• Providers in Watseka, IL by specialty
• Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2022; 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.