Carrie Petrelli, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149024332 Issued in IL

Practice address

1803 E Basswood LN
Mount Prospect, IL 60056-1809

Phone

(773) 620-0128

NPI assigned

Jun 14, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1655164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655164800000",
    "number": "1689304511",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1803 E BASSWOOD LN",
            "city": "MOUNT PROSPECT",
            "state": "IL",
            "postal_code": "600561809",
            "telephone_number": "773-620-0128"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1803 E BASSWOOD LN",
            "city": "MOUNT PROSPECT",
            "state": "IL",
            "postal_code": "600561809",
            "telephone_number": "773-620-0128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRELLI",
        "first_name": "CARRIE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-14",
        "last_updated": "2022-06-14",
        "certification_date": "2022-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149024332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pediatric Medicine
• Elizabeth Mora Perez, M.D.
• Donovan Edward Perry
• Jason R Perry, R.PH.
• Kelsey Persels
• Dina Petricca, PT
• Alyssa Nicole Petty, PT, DPT
• Lindsey Lee Phelps, M.S., CCC-SLP
• Priyanka Philip
• Amalia Phillips

• Clinical Social Worker in Mount Prospect, IL
• Providers in Mount Prospect, 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 Jun 14, 2022; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.