Jon Petruschke LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

Legal business name

JON PETRUSCHKE LLC

Practice address

145 Newbury St
Suite 2
Portland, ME 04101-4261

Phone

(207) 774-9667

NPI assigned

Apr 24, 2017

Organization subpart

No

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

Authorized official

Name

Jon PetruschkeNPI 1306021910

Title

Social Worker

Phone

(207) 774-9667

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ME

Enrollment records 1

Locations

Practitioners 1

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

• Jon P Petruschke, LCSW

  • Clinical Social Worker
  • NPI 1306021910

  ME

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1492992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492992000000",
    "number": "1528593985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 HOWARD ST",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041013208",
            "telephone_number": "207-774-9667"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 NEWBURY ST",
            "address_2": "SUITE 2",
            "city": "PORTLAND",
            "state": "ME",
            "postal_code": "041014261",
            "telephone_number": "207-774-9667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JON PETRUSCHKE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-04-24",
        "last_updated": "2017-04-24",
        "status": "A",
        "authorized_official_last_name": "PETRUSCHKE",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "SOCIAL WORKER",
        "authorized_official_telephone_number": "207-774-9667"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven C Johnston, PT
• Katie Johnstone, PHARMD
• Logan Joldersma
• Renee Nicole Joles, LCPC
• Katherine Jolley, DO
• Jonathan C Fellers MD PA LLC
• Chanelle Jones
• Christopher T Jones, LCPC
• Gabrielle Yvonne Jones, CCC-SLP
• Garlic Jones

• Clinical Social Worker in Portland, ME
• Providers in Portland, ME by specialty
• Clinical Social Worker in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.