MEDICARE: CHERYL ANN PETROZZI LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CSW.00992398	CO
2	1041C0700X	Clinical Social Worker	LICSW126528	MA

General Provider Information

NPI Number	:	1518667906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL ANN PETROZZI LCSW

Provider Business Mailing Address
First Line	:	12 JOSEPH RD
Second Line	:
City	:	EAST DOUGLAS
State	:	MA
Zip	:	01516-2474
Country	:	US
Telephone Number	:	719-339-4086
Fax Number	:

Provider Business Practice Location Address
First Line	:	12 JOSEPH RD
Second Line	:
City	:	EAST DOUGLAS
State	:	MA
Zip	:	01516-2474
Country	:	US
Telephone Number	:	719-339-4086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2023
Last Update Date	:	06/08/2023

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