Stacy Golboro Hanak

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW017974 Issued in PA

Practice address

191 Presidential Blvd Ste C129
Bala Cynwyd, PA 19004-1216

Phone

(484) 334-8211

NPI assigned

Mar 24, 2014

Last updated

Jan 26, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1395619200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1611619200000",
    "number": "1073930418",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 ARCH ST 5",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191031300",
            "telephone_number": "267-256-2115"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 PRESIDENTIAL BLVD STE C129",
            "city": "BALA CYNWYD",
            "state": "PA",
            "postal_code": "190041216",
            "telephone_number": "484-334-8211"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10125 Verree Rd",
            "address_2": "Suite 304",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191163611",
            "country_code": "US",
            "telephone_number": "267-256-2262",
            "fax_number": "267-256-2251",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "HANAK",
        "first_name": "STACY",
        "middle_name": "GOLBORO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-03-24",
        "last_updated": "2021-01-26",
        "certification_date": "2021-01-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW017974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Social Worker in Bala Cynwyd, PA
• Providers in Bala Cynwyd, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.