Active NPI
Amy Louise Petrill, LISW
- Social Worker
- Medina, OH
National Provider Identifier
1407304470
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- I.2002101
- Practice address
- 4018 Medina Rd Ste D
Medina, OH 44256-9675 - Phone
- (330) 722-4166
- NPI assigned
- Sep 19, 2016
- 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 |
|---|---|---|---|---|
| Social Worker | 104100000X | I.2002101 | OH | Primary |
Addresses
Primary practice location
4018 Medina Rd Ste D
Medina, OH 44256-9675
Mailing address
19016 Turkey Meadow LN
Strongsville, OH 44136-6449
Phone (440) 570-7755
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2488428 | Medicaid | OH |
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| I.2002101 | OH | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1474243200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631491200000",
"number": "1407304470",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19016 TURKEY MEADOW LN",
"city": "STRONGSVILLE",
"state": "OH",
"postal_code": "441366449",
"telephone_number": "440-570-7755"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4018 MEDINA RD STE D",
"city": "MEDINA",
"state": "OH",
"postal_code": "442569675",
"telephone_number": "330-722-4166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRILL",
"first_name": "AMY",
"middle_name": "LOUISE",
"credential": "LISW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-09-19",
"last_updated": "2021-09-13",
"certification_date": "2021-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "OH",
"license": "I.2002101",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2488428",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medina, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.