Individual provider Active NPI

Julie A Pettinato, LCSW

  • Clinical Social Worker
  • Waukegan, IL
National Provider Identifier
1447531777
Registry record updated Aug 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
149.014706 Issued in IL
Practice address
3010 Grand Ave
Waukegan, IL 60085-2321
Phone
(847) 377-8950
Fax
(847) 377-8808
NPI assigned
Aug 31, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 149.014706 IL Primary

Addresses

Primary practice location

3010 Grand Ave
Waukegan, IL 60085-2321

Mailing address

34068 N White Oak LN
Gurnee, IL 60031-4446
Phone (847) 962-9549

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120410000379 IL Practitioner - Clinical Social Worker 0547421042 Reassigns benefits to 1 organization
Receives reassigned benefits from 1 practitioner
Practice locations: Grayslake, IL

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Loyola University of Chicago, Stritch School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Counseling Center of Grayslake LTDGroup PAC ID 7214214378, 11 clinicians

Practice addresses (Care Compare)

106 Ctr St
Grayslake, IL 60030-1533
Phone (847) 549-2235

1190 E Washington St
Grayslake, IL 60030-7960
Phone (847) 549-2235

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
149.014706ILMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Counseling Center of Grayslake LTD. Clinical CurrentSince May 15, 2017 Accepting new patients
Counseling Center of Grayslake PastSince Aug 22, 2016 Accepting new patients
Kimberly a. Kick, LCSW & Associates, LTD. Past Accepting new patients

Locations

106 Center St
Grayslake, IL 60030
Phone (847) 543-8400

1190 E Washington St
Grayslake, IL 60030
Phone (847) 477-0434

142 Hawley St
Ste 5
Grayslake, IL 60030
Phone (847) 549-2235

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Organizations & group practices 3

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

NPI Registry JSON

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

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314748800000",
    "number": "1447531777",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "34068 N WHITE OAK LN",
            "city": "GURNEE",
            "state": "IL",
            "postal_code": "600314446",
            "telephone_number": "847-962-9549",
            "fax_number": "847-377-8808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3010 GRAND AVE",
            "city": "WAUKEGAN",
            "state": "IL",
            "postal_code": "600852321",
            "telephone_number": "847-377-8950",
            "fax_number": "847-377-8808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETTINATO",
        "first_name": "JULIE",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-08-31",
        "last_updated": "2011-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.014706",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waukegan, IL

Sources for this page

Verify at the official NPI Registry.