| Counseling Center Of Grayslake Ltd. | |
|
142 Hawley St Ste 5 Grayslake IL 60030-3653 | |
| (847) 962-9549 | |
| Not Available |
| Full Name | Counseling Center Of Grayslake Ltd. |
|---|---|
| Speciality | Social Worker |
| Location | 142 Hawley St Ste 5, Grayslake, Illinois |
| Authorized Official Name and Position | Julie Pettinato (MANAGING DIRECTOR) |
| Authorized Official Contact | 8479629549 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Counseling Center Of Grayslake Ltd. 1190 E Washington St Grayslake IL 60030-7960 Ph: (847) 962-9549 | Counseling Center Of Grayslake Ltd. 142 Hawley St Ste 5 Grayslake IL 60030-3653 Ph: (847) 962-9549 |
| NPI Number | 1194267385 |
|---|---|
| Provider Enumeration Date | 11/06/2016 |
| Last Update Date | 02/24/2022 |
| Certification Date | 02/24/2022 |
| Medicare PECOS PAC ID | 7214214378 |
|---|---|
| Medicare Enrollment ID | O20170427002620 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1194267385 | NPI | - | NPPES |
| F300232686 | Other | IL | MEDICARE PTAN |
| 149.014706 | Other | IL | LICENSE - SOCIAL WORKER, CLINICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Julie A Pettinato |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1447531777 PECOS PAC ID: 0547421042 Enrollment ID: I20120410000379 |
| Provider Name | Charles E Hutchcraft |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1033483490 PECOS PAC ID: 4284929944 Enrollment ID: I20160822000030 |
| Provider Name | Patricia M Stern |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902329279 PECOS PAC ID: 6305111758 Enrollment ID: I20171011000572 |
| Provider Name | Rachel Gagel Risler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932618816 PECOS PAC ID: 1850659582 Enrollment ID: I20171229000526 |
| Provider Name | Faya Kacos-shiu |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1194118802 PECOS PAC ID: 3173884392 Enrollment ID: I20180305002258 |
| Provider Name | Paulina Birgiolaite |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1659871028 PECOS PAC ID: 0042616591 Enrollment ID: I20210908002168 |
| Provider Name | Dominic J Caputa |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1851672398 PECOS PAC ID: 1557522059 Enrollment ID: I20230620002680 |
| Provider Name | Aryn Rose |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1902365075 PECOS PAC ID: 9335593409 Enrollment ID: I20230922001069 |
| Provider Name | Richard Gauthier |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053083899 PECOS PAC ID: 2668818162 Enrollment ID: I20240306003836 |
| Provider Name | Deborah Vanderwall |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1437645835 PECOS PAC ID: 9032555362 Enrollment ID: I20240308003399 |
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