Mary Petro LCSW PLLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

MARY PETRO LCSW PLLC

Practice address

415 S Mulford Rd
Rockford, IL 61108-3011

Phone

(779) 910-5001

Fax

(815) 399-5767

NPI assigned

Sep 20, 2024

Organization subpart

No

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

Authorized official

Name

Mary M Petro, LCSWNPI 1851123509

Title

Member

Phone

(779) 910-5001

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mary M Petro, LCSW

  • Clinical Social Worker
  • Rockford, IL
  • NPI 1851123509
  NPD Authorized official

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

{
    "created_epoch": "1726790400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1726790400000",
    "number": "1447077615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11166 FYVIE CT",
            "city": "BELVIDERE",
            "state": "IL",
            "postal_code": "610087408",
            "telephone_number": "779-910-5001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 S MULFORD RD",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611083011",
            "telephone_number": "779-910-5001",
            "fax_number": "815-399-5767"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY PETRO LCSW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-20",
        "last_updated": "2024-09-20",
        "certification_date": "2024-09-20",
        "status": "A",
        "authorized_official_last_name": "PETRO",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "779-910-5001",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven Eugene Martinson, RPH
• Kristen Lynn Marvel
• Lindsay Marvick
• Mary C. Fairchild, LCSW, LLC
• Mary C. Gurney, PC
• Angela Rose Mascharka, L.C.S.W.
• Andrew J Masterson, PA-C
• Masterton Billing, LLC
• Ronald A Masukawa, DC
• Mohammad Matarbazi Almonajed, M.D.

• Clinical Social Worker in Rockford, IL
• Providers in Rockford, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2024; 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.