Ursula Ann Petrik, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

087670-01 Issued in NY

Practice address

146 Pike St
Port Jervis, NY 12771-1808

Phone

(845) 858-1456

Fax

(845) 378-3283

NPI assigned

Feb 27, 2023

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

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1677456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1677456000000",
    "number": "1912606187",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "295 COUNTY ROUTE 93",
            "city": "NEW HAMPTON",
            "state": "NY",
            "postal_code": "109584411",
            "telephone_number": "516-318-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "146 PIKE ST",
            "city": "PORT JERVIS",
            "state": "NY",
            "postal_code": "127711808",
            "telephone_number": "845-858-1456",
            "fax_number": "845-378-3283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRIK",
        "first_name": "URSULA",
        "middle_name": "ANN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-02-27",
        "last_updated": "2023-02-27",
        "certification_date": "2023-02-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "087670-01",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Orange County Dept of Menttal Health
• Edward Orlando, MD
• Pain and Neuropathy Center of PA PC
• Lindsay Pallini, FNP
• Jeffrey A Parker, DPM
• Tina Marie Pfaffe, MASTER OF ARTS
• Ram Phull, D.D.S.
• Physical Therapy Professional Care, PC
• Samantha Jade Piatt
• Edward Plotzker, MD

• Clinical Social Worker in Port Jervis, NY
• Providers in Port Jervis, 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 Feb 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.