Active NPI
Christine Renee Petro, PSY.D.
- Clinical Child & Adolescent Psychologist
- Greenville, SC
National Provider Identifier
1740329176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Child & Adolescent Psychologist
- License
- 1840
- Practice address
- 109 Laurens Rd Ste D
Greenville, SC 29607-1860 - Phone
- (864) 668-2505
- Fax
- (864) 305-3010
- NPI assigned
- Feb 5, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY003011 | GA | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | PSY003011 | GA | |
| Clinical Child & Adolescent Psychologist | 103TC2200X | 1840 | SC | Primary |
Addresses
Primary practice location
109 Laurens Rd Ste D
Greenville, SC 29607-1860
Mailing address
109 Laurens Rd Ste D
Greenville, SC 29607-1860
Phone (864) 668-2505
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 |
|---|---|---|---|
| PSY003011 | GA | MD | Clinical Psychologist |
| 1840 | SC | MD | Clinical Child & Adolescent Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Christine R Petro, Psy.D., LLC | Clinical | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Clinical Child & Adolescent Psychologist
- Grayson, GA
- NPI 1023341518
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727049600000",
"number": "1740329176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "109 LAURENS RD STE D",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296071860",
"telephone_number": "864-668-2505",
"fax_number": "864-305-3010"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "109 LAURENS RD STE D",
"city": "GREENVILLE",
"state": "SC",
"postal_code": "296071860",
"telephone_number": "864-668-2505",
"fax_number": "864-305-3010"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETRO",
"first_name": "CHRISTINE",
"middle_name": "RENEE",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-02-05",
"last_updated": "2024-09-23",
"certification_date": "2024-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "GA",
"license": "PSY003011",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "GA",
"license": "PSY003011",
"primary": false
},
{
"code": "103TC2200X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical Child & Adolescent",
"state": "SC",
"license": "1840",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.