Healthcare Provider Details

I. General information

NPI: 1306281332
Provider Name (Legal Business Name): LISA MARIE PETRONGELLI PSY.D, APRN-BC, FPA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 MOON LAKE BLVD
HOFFMAN ESTATES IL
60169-1010
US

IV. Provider business mailing address

1776 MOON LAKE BLVD
HOFFMAN ESTATES IL
60169-1010
US

V. Phone/Fax

Practice location:
  • Phone: 847-882-4181
  • Fax: 847-882-4299
Mailing address:
  • Phone: 847-228-4181
  • Fax: 847-882-4299

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277000902
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number277000902
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277000902
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 8
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209004881
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number
License Number State
# 10
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number277000902
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: