Individual provider Active NPI

Rosanne Connolly, SOCIAL WORKER

  • Clinical Social Worker
  • South Amboy, NJ
National Provider Identifier
1083840649
Registry record updated Oct 10, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05479900 Issued in NJ
Practice address
1 Main St
South Amboy, NJ 08879-1142
Phone
(732) 727-2555
NPI assigned
Jun 9, 2009
Last updated
Oct 10, 2017By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 37LC00184700 NJ
Clinical Social Worker 1041C0700X 44SC05479900 NJ Primary

Addresses

Primary practice location

1 Main St
South Amboy, NJ 08879-1142

Mailing address

21 Lenard Way
Parsippany, NJ 07054-4365
Phone (973) 714-2210

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130108000016 NJ Practitioner - Clinical Social Worker 2163675851 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

55 Woodland Ave
Summit, NJ 07901-2225
Phone (973) 714-2210

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
44SC05479900NJMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Behavioral Change Through Counseling, LLC Addiction (Substance Use Disorder) CurrentSince Nov 1, 2012 Accepting new patients

Locations

55 Woodland Ave
Summit, NJ 07901
Phone (908) 246-0869

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507593600000",
    "number": "1083840649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 LENARD WAY",
            "city": "PARSIPPANY",
            "state": "NJ",
            "postal_code": "070544365",
            "telephone_number": "973-714-2210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MAIN ST",
            "city": "SOUTH AMBOY",
            "state": "NJ",
            "postal_code": "088791142",
            "telephone_number": "732-727-2555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "ROSANNE",
        "credential": "SOCIAL WORKER",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-09",
        "last_updated": "2017-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00184700",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05479900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Amboy, NJ

Sources for this page

Verify at the official NPI Registry.