Active NPI
Robert Petite, LMFT-IL
- Group Psychotherapy Psychologist
- Chicago, IL
National Provider Identifier
1487127668
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Group Psychotherapy Psychologist
- License
- 166.000245
- Practice address
- 4717 S Greenwood Ave
Chicago, IL 60615-1933 - Phone
- (773) 164-8190
- NPI assigned
- Jan 9, 2019
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Group Psychotherapy Psychologist | 103TP2701X | 166.000245 | IL | Primary |
Addresses
Primary practice location
4717 S Greenwood Ave
Chicago, IL 60615-1933
Mailing address
4717 S Greenwood Ave
Chicago, IL 60615-1933
Phone (773) 164-8190
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 166.000245 | Other | IL | STATE OF ILLINOIS |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 166.000245 | IL | MD | Group Psychotherapy Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1546992000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1546992000000",
"number": "1487127668",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4717 S GREENWOOD AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606151933",
"telephone_number": "773-164-8190"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4717 S GREENWOOD AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606151933",
"telephone_number": "773-164-8190"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETITE",
"first_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "LMFT-IL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-09",
"last_updated": "2019-01-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TP2701X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Psychologist, Group Psychotherapy",
"state": "IL",
"license": "166.000245",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF ILLINOIS",
"identifier": "166.000245",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.