Individual provider · Type 1 NPI

Jon P. Petruschke, LCSW

Clinical Social Worker · Portland, UM

NPI number 1306021910 Active

Practice location

145 Newbury Street, Ste 2
Portland, UM 04101

Mailing address

21 Howard St
Portland, ME 04101-3208

Specialties and licenses

TaxonomyCodeLicense
Clinical Social Worker Primary 1041C0700XLC8835 (ME)

Clinical Social Worker: A social worker who holds a master's or doctoral degree in social work from an accredited school of social work in addition to at least two years of post-master's supervised experience in a clinical setting. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice. A clinical social worker provides direct services, including interventions focused on interpers…

About NPI 1306021910

Jon P. Petruschke, LCSW's National Provider Identifier is 1306021910, issued on Jan 2, 2008. The primary taxonomy on file is Clinical Social Worker (1041C0700X), and the practice location is in Portland, UM. The record was last updated on Apr 26, 2017.