Grazyna Gabriela Petersen, LCSW, CADC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.021092 Issued in IL

Practice address

4300 Commerce CT Ste 300-3
Lisle, IL 60532-3709

Phone

(773) 739-0992

Fax

(773) 733-4119

NPI assigned

Apr 8, 2019

Last updated

Dec 15, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Clinical Social Worker

Education

Other, 2016

Medicare assignment

May accept Medicare assignment

Group practices

Contemporary Wellness, LLCGroup PAC ID 9830520436, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Contemporary Wellness, LLC

  • Clinical Social Worker
  • Lisle, IL
  • NPI 1326675760

  Addiction (Substance Use Disorder)

  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1554681600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607990400000",
    "number": "1457814360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4300 COMMERCE CT STE 300-3",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323709",
            "telephone_number": "773-739-0992",
            "fax_number": "773-733-4119"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4300 COMMERCE CT STE 300-3",
            "city": "LISLE",
            "state": "IL",
            "postal_code": "605323709",
            "telephone_number": "773-739-0992",
            "fax_number": "773-733-4119"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSEN",
        "first_name": "GRAZYNA",
        "middle_name": "GABRIELA",
        "credential": "LCSW, CADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-04-08",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "IL",
            "license": "33287",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.021092",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Eye Specialists
• Kary Pekarek, LCSW
• Joseph Pepitone, MD
• Personal Growth Psychiatry PLLC (Growth Behavioral Health)
• Ashley Peters, FNP-C
• Ann Marie Peterson, LSW
• Christina Phillips, M.A. CCC-SLP
• Annabella Maria Picchi
• Coral Nicole Pidone, LCPC
• Matthew E Pilditch, MD

• Clinical Social Worker in Lisle, IL
• Providers in Lisle, 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 Dec 15, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.