Healthcare Provider Details

I. General information

NPI: 1558421438
Provider Name (Legal Business Name): PETA MINEROF-BARTOS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LAKE COOK RD STE 300
NORTHBROOK IL
60062-1060
US

IV. Provider business mailing address

4201 LAKE COOK RD STE 300
NORTHBROOK IL
60062-1060
US

V. Phone/Fax

Practice location:
  • Phone: 847-871-9900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number178.0017123
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number016004669
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: