Therese Connolly, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS20482 Issued in CA

Practice address

801 Traeger Ave
2ND Floor, Child Psychiatry
San Bruno, CA 94066-3048

Phone

(650) 742-2503

NPI assigned

Jan 25, 2007

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1169683200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641168000000",
    "number": "1235285107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 TRAEGER AVE",
            "address_2": "2ND FL, CHILD AND ADOL PSYCHIATRY",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940663048",
            "telephone_number": "650-742-2502"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "801 TRAEGER AVE",
            "address_2": "2ND FLOOR, CHILD PSYCHIATRY",
            "city": "SAN BRUNO",
            "state": "CA",
            "postal_code": "940663048",
            "telephone_number": "650-742-2503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "THERESE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-01-25",
        "last_updated": "2022-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS20482",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1150 Veterans Blvd",
            "city": "Redwood City",
            "state": "CA",
            "country_code": "US",
            "postal_code": "940632037",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Elisha Coleman
• Kahreemah Coleman
• Donald Brian Conkling, DVM
• Crystalee Connelly
• Connie K Ha OD, Professional Corporation
• Kaebeth Contreras
• William Richardson Cooper II
• Veronica Coppolino
• Lydia Iris Cordonero, MSW INTERN
• Ma Rocle Correa

• Clinical Social Worker in San Bruno, CA
• Providers in San Bruno, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2022; 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.