Provider Demographics
NPI:1902023245
Name:SHERRY PETRO & ASSOC
Entity Type:Organization
Organization Name:SHERRY PETRO & ASSOC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:PETRO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:708-535-3132
Mailing Address - Street 1:9615 S MILLARD AVE
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-2910
Mailing Address - Country:US
Mailing Address - Phone:708-535-3132
Mailing Address - Fax:708-346-6169
Practice Address - Street 1:14525 WALDEN CT
Practice Address - Street 2:
Practice Address - City:OAK FOREST
Practice Address - State:IL
Practice Address - Zip Code:60452-1074
Practice Address - Country:US
Practice Address - Phone:708-535-3132
Practice Address - Fax:708-346-6169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490041791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty