Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Stanley O Pettegrow, LCSW

Individual provider Clinical Social Worker · NPI 1487674859

Stanley O Pettegrow, LCSW is a Clinical Social Worker in Old Town, Maine. Qualified in 2005, 21 years ago. Practices with Penobscot Community Health Center, a 132-clinician group and accepts Medicare assignment. Licensed in Maine.

Years since qualifying
21
Licensed in
ME
In the registry since
2006
What do these letters mean?
LCSW — Licensed Clinical Social Worker
A social worker licensed to diagnose and treat mental health conditions independently.

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Practice location Address checks out

242 Brunswick St
Old Town, ME 04468-1613
Phone: (207) 827-6128
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Clinical Social Worker (primary) Taxonomy 1041C0700X · Licence LC11074 (ME)

Record details

NPI number1487674859
Entity typeIndividual (Type 1)
GenderMale
Credentials LCSW
Sole proprietorNo
NPI enumeratedJuly 20, 2006
Last updated in NPPESMay 5, 2021
Certification dateMay 5, 2021

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyCLINICAL SOCIAL WORKER
Medical schoolOTHER
Graduated 2005 (21 years in practice)
Group practice Penobscot Community Health Center — 132 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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