1023191418 NPI number — DR. CHERYL A DEPETRO MSW,LCSW-C, DAC, LAC

Table of content: DR. CHERYL A DEPETRO MSW,LCSW-C, DAC, LAC (NPI 1023191418)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023191418 NPI number — DR. CHERYL A DEPETRO MSW,LCSW-C, DAC, LAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEPETRO
Provider First Name:
CHERYL
Provider Middle Name:
A
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MSW,LCSW-C, DAC, LAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023191418
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 NEWBURG AVE STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-5168
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-747-9743
Provider Business Mailing Address Fax Number:
410-747-9910

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 EDMONDSON AVE
Provider Second Line Business Practice Location Address:
SUITE #201
Provider Business Practice Location Address City Name:
CATONSVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21228-3315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-747-9743
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  U01507 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 09177 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 149702200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 228677 . This is a "COMPSYCH" identifier . This identifiers is of the category "OTHER".
  • Identifier: QF72 . This is a "BCBS OF MD & NATIONAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204657996 . This is a "ATENA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204657996 . This is a "KAISER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 232401 . This is a "APS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 543427000 . This is a "MAGELLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 6527 . This is a "BCBS FEDERAL AND BLUE CHO" identifier . This identifiers is of the category "OTHER".




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