Provider Demographics
NPI:1023191418
Name:DEPETRO, CHERYL A (MSW,LCSW-C, DAC, LAC)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:A
Last Name:DEPETRO
Suffix:
Gender:F
Credentials:MSW,LCSW-C, DAC, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 NEWBURG AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5168
Mailing Address - Country:US
Mailing Address - Phone:410-747-9743
Mailing Address - Fax:410-747-9910
Practice Address - Street 1:606 EDMONDSON AVE
Practice Address - Street 2:SUITE #201
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-3315
Practice Address - Country:US
Practice Address - Phone:410-747-9743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2022-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01507171100000X
MD091771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD149702200Medicaid
228677OtherCOMPSYCH
QF72OtherBCBS OF MD & NATIONAL
204657996OtherATENA
204657996OtherKAISER
232401OtherAPS
543427000OtherMAGELLAN
6527OtherBCBS FEDERAL AND BLUE CHO
QF72OtherBCBS OF MD & NATIONAL