Shannon Dexter Petrovich, LCSW, LISAC is a medicare enrolled "Social Worker - Clinical" provider in Tucson, Arizona. She graduated from healthcare school in 1988 and has 37 years of diverse experience with area of expertise as Clinical Social Worker. She is a member of the group practice Aleph Center, P.l.l.c. and her current practice location is
5855 N Kolb Rd Unit 4208, Tucson, Arizona. You can reach out to her office (for appointments etc.) via phone at
(520) 909-4740.
Shannon Dexter Petrovich is licensed to practice in Arizona (license number LCSW-4024) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1104374255.
Healthcare Provider's Profile
| Full Name | Shannon Dexter Petrovich |
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| Gender | Female |
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| Speciality | Clinical Social Worker |
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| Experience | 37 Years |
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| Location | 5855 N Kolb Rd Unit 4208, Tucson, Arizona |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Shannon Dexter Petrovich graduated from medical school in 1988
NPI Data:
- NPI Number: 1104374255
- Provider Enumeration Date: 09/19/2016
- Last Update Date: 09/19/2016
Medicare PECOS Information:
- PECOS PAC ID: 7719941293
- Enrollment ID: I20041115000769
Medical Identifiers
Medical identifiers for Shannon Dexter Petrovich such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1104374255 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 101YA0400X | Counselor - Addiction (substance Use Disorder) | LISAC-1365 (Arizona) | Secondary |
| 1041C0700X | Social Worker - Clinical | LCSW-4024 (Arizona) | Primary |
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Aleph Center, P.l.l.c. | 0143209809 | 10 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Shannon Dexter Petrovich allows following entities to bill medicare on her behalf.
| Entity Name | Aleph Center, P.l.l.c. |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1215022157
PECOS PAC ID: 0143209809
Enrollment ID: O20040715001337 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shannon Dexter Petrovich is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Shannon Dexter Petrovich, LCSW, LISAC
5855 N Kolb Rd Unit 4208,
Tucson, AZ 85750-0991
Ph: (520) 909-4740 | Shannon Dexter Petrovich, LCSW, LISAC
5855 N Kolb Rd Unit 4208,
Tucson, AZ 85750-0991
Ph: (520) 909-4740 |
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