Active NPI
Sheri Lynn Petruso, MSW, LCSW
- Clinical Social Worker
- Saint Peters, MO
National Provider Identifier
1598865446
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 005052
- Practice address
- 1600 Heritage Landing
Suite 116
St Peters, MO 63303 - Phone
- (636) 345-1400
- Fax
- (636) 441-3262
- NPI assigned
- Sep 22, 2006
- Last updated
- Apr 28, 2010
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 005052 | MO | Primary |
Addresses
Primary practice location
1600 Heritage Landing
Suite 116
St Peters, MO 63303
Mailing address
1600 Heritage Landing
Suite 116
St Peters, MO 63303
Phone (636) 345-1400
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 498946417 | Medicaid | MO |
Other names 1
- Sheri Lynn Fernandez
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 |
|---|---|---|---|
| 005052 | MO | MD | Occupational Therapy Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dragonfly Wellness, LLC | Past | Accepting new patients | |
| Collaborative Counseling, LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Counselor
- Saint Peters, MO
- NPI 1952401812
-
- Professional Counselor
- Saint Peters, MO
- NPI 1346989266
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158883200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1272412800000",
"number": "1598865446",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 HERITAGE LANDING",
"address_2": "SUITE 116",
"city": "ST PETERS",
"state": "MO",
"postal_code": "63303",
"telephone_number": "636-345-1400",
"fax_number": "636-441-3262"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 HERITAGE LANDING",
"address_2": "SUITE 116",
"city": "ST PETERS",
"state": "MO",
"postal_code": "63303",
"telephone_number": "636-345-1400",
"fax_number": "636-441-3262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRUSO",
"first_name": "SHERI",
"middle_name": "LYNN",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-22",
"last_updated": "2010-04-28",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MO",
"license": "005052",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "498946417",
"state": "MO"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "SHERI",
"last_name": "FERNANDEZ",
"middle_name": "LYNN",
"credential": "MSW LCSW",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Saint Peters, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.