Individual provider Active NPI

Tyler Connifey, LCSW

  • Clinical Social Worker
  • Fayetteville, NC
National Provider Identifier
1104601913
Registry record updated Aug 14, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
5095 Issued in HI
Practice address
3011 Town Center Dr Ste 130
Fayetteville, NC 28306-0049
Phone
(910) 212-6101
NPI assigned
Aug 29, 2023
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 14, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 5095 HI Primary
Clinical Social Worker 1041C0700X C019004 NC
Military Health Care Provider 171000000X 001084104 HI

Addresses

Primary practice location

3011 Town Center Dr Ste 130
Fayetteville, NC 28306-0049

Mailing address

2817 Rock Merritt Ave Womack Army Medical Center
Fort Liberty, NC 28310-0001
Phone (910) 907-8922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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
I20260305002718 NC Practitioner - Clinical Social Worker 1153803473 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

2261 Market St
San Francisco, CA 94114-1612

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
5095HIMDClinical Social Worker
C019004NCMDClinical Social Worker
001084104HIMDMilitary Health Care Provider

Practice roles

OrganizationSpecialtyStatusNew patients
Brightside Medical of New Jersey, P.C. CurrentSince Feb 1, 2026 Accepting new patients
Connifey Counseling & Wellness, PLLC Clinical Current Accepting new patients

Locations

3011 Town Center Dr
Ste 130
Fayetteville, NC 28306
Phone (910) 469-1342

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1693267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786665600000",
    "number": "1104601913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2817 ROCK MERRITT AVE WOMACK ARMY MEDICAL CENTER",
            "city": "FORT LIBERTY",
            "state": "NC",
            "postal_code": "283100001",
            "telephone_number": "910-907-8922",
            "fax_number": "910-907-6069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3011 TOWN CENTER DR STE 130",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283060049",
            "telephone_number": "910-212-6101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNIFEY",
        "first_name": "TYLER",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-08-29",
        "last_updated": "2026-08-14",
        "certification_date": "2026-08-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "HI",
            "license": "5095",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C019004",
            "primary": false
        },
        {
            "code": "171000000X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider",
            "state": "HI",
            "license": "001084104",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, NC

Sources for this page

Verify at the official NPI Registry.