Kelly Anne Petravicz, M.ED.

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LICSW1141675 Issued in MA

Practice address

370 Merrimack St Ste 120
Lawrence, MA 01843-1789

Phone

(978) 620-0290

NPI assigned

Sep 1, 2010

Sex

Female

Sole proprietor

No

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

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Education

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.

• South Bay Mental Health Center

  • Community/Behavioral Health Agency
  • Lowell, MA
  • NPI 1790092088
  NPD (past)

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

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775779200000",
    "number": "1710294483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "370 MERRIMACK ST BLDG 5",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018431788",
            "telephone_number": "978-620-0290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "370 MERRIMACK ST STE 120",
            "city": "LAWRENCE",
            "state": "MA",
            "postal_code": "018431789",
            "telephone_number": "978-620-0290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRAVICZ",
        "first_name": "KELLY",
        "middle_name": "ANNE",
        "name_prefix": "Mrs.",
        "credential": "M.ED.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-09-01",
        "last_updated": "2026-04-10",
        "certification_date": "2026-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MA",
            "license": "LICSW1141675",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perrotta'S Pharmacy
• Elizabeth Brookfield Perry, RN
• Sumatee Persad
• Jonathan Clark Peters, DO
• Christopher David Peterson, LADC 1
• Kristi Lee Petri, MSW
• Patricia A Petropoulos, M.A.
• Lisa R Petrowski
• Sothea Phaen, PHARM D
• Nhat M Phan, DMD

• Clinical Social Worker in Lawrence, MA
• Providers in Lawrence, MA by specialty
• Clinical Social Worker in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2026; 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.