| Doctor Name: | STANLEY O PETTEGROW |
| NPI Number: | 1487674859 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | LC11074 |
| Business Practice Address: | 242 Brunswick St Old Town, ME - 044681613 |
| Business Phone Number: | 2078276128 |
| Business Fax Number: | |
| Mailing Address: | Po Box 1599, BANGOR |
| State: | ME |
| Postal Code: | 044021599 |
| Phone Number: | 2079455247 |
| Fax Number: | |
| NPI Enumeration Date: | 07/20/2006 |
| NPI Last Update Date: | 01/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LC11074 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | ME |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |