Emily Marie Petrus, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

085870-1 Issued in NY

Practice address

28 William St
Gouverneur, NY 13642-1405

Phone

(315) 287-2811

NPI assigned

Dec 2, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other names 1

• Miss Emily Marie Kuntz Former name

Medicare fee-for-service enrollment

Enrolled in NY

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

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• St. Lawrence Psychiatric Center

  • Community/Behavioral Health Agency
  • Gouverneur, NY
  • NPI 1669811881
  NPD (past)
• St. Lawrence Psychiatric Center

  • Community/Behavioral Health Agency
  • Gouverneur, NY
  • NPI 1780135749
  NPD (past)

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

{
    "created_epoch": "1385942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667952000000",
    "number": "1700217759",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 WILLIAM ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421405",
            "telephone_number": "315-287-2811"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "28 WILLIAM ST",
            "city": "GOUVERNEUR",
            "state": "NY",
            "postal_code": "136421405",
            "telephone_number": "315-287-2811"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUS",
        "first_name": "EMILY",
        "middle_name": "MARIE",
        "name_prefix": "Mrs.",
        "credential": "LCSW-R",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-12-02",
        "last_updated": "2022-11-09",
        "certification_date": "2022-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "089822",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "085870-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EMILY",
            "last_name": "KUNTZ",
            "middle_name": "MARIE",
            "prefix": "MISS",
            "credential": "LMSW, LCSW",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Timothy O'Connor, R.PH.
• Tanya Sue Parker
• Tonya L Patton, LPN
• Aimee K Pecori, OD
• Catherine Marie Perrigo, PHARM.D.
• Thuc Duy Phan, M.D.
• Elizabeth Pharoah, PHARMD
• Doris M Platt, RN
• Proact Pharmacy Services, Inc.
• Rachel I. Raven Family Health Nurse Practitioner, PLLC

• Clinical Social Worker in Gouverneur, NY
• Providers in Gouverneur, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.