NPIMap

Organization Active NPI

Connellsville Counseling & Psychological Services, LLC

  • Community/Behavioral Health Agency
  • Connellsville, PA
National Provider Identifier
1275844789
Registry record updated Jun 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Behavioral Health AgencyTaxonomy code 251S00000X
License
TO BE ASSIGNED Issued in PA
Legal business name
CONNELLSVILLE COUNSELING & PSYCHOLOGICAL SERVICES, LLC
Practice address
416 S Pittsburgh St
Connellsville, PA 15425-4003
Phone
(724) 626-8420
Fax
(724) 628-0898
NPI assigned
Jun 30, 2010
Last updated
Jun 30, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2010

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

Authorized official

Name
Roxane Mongelluzzo, LCSWNPI 1285690891
Title
Clinical Director
Phone
(724) 626-8420

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community/Behavioral Health Agency 251S00000X TO BE ASSIGNED PA Primary

Addresses

Primary practice location

416 S Pittsburgh St
Connellsville, PA 15425-4003

Mailing address

416 S Pittsburgh St
Connellsville, PA 15425-4003
Phone (724) 626-8420

Other identifiers 1

IdentifierTypeStateIssuer
TO BE ASSIGNEDMedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120307000144 PA Part B Supplier - Clinic/Group Practice 3274792536 Receives reassigned benefits from 11 practitioners
Practice locations: Connellsville, PA; Mt Pleasant, PA

National Provider Directory

National Provider Directory
Tax ID family
Connellsville Counseling Psychological Services2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

412 S Pittsburgh St
Connellsville, PA 15425
Phone (724) 626-8420

Practitioners & affiliated clinicians

Practitioners 15

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1277856000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277856000000",
    "number": "1275844789",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "416 S PITTSBURGH ST",
            "city": "CONNELLSVILLE",
            "state": "PA",
            "postal_code": "154254003",
            "telephone_number": "724-626-8420",
            "fax_number": "724-628-0898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "416 S PITTSBURGH ST",
            "city": "CONNELLSVILLE",
            "state": "PA",
            "postal_code": "154254003",
            "telephone_number": "724-626-8420",
            "fax_number": "724-628-0898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CONNELLSVILLE COUNSELING & PSYCHOLOGICAL SERVICES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-30",
        "last_updated": "2010-06-30",
        "status": "A",
        "authorized_official_last_name": "MONGELLUZZO",
        "authorized_official_first_name": "ROXANE",
        "authorized_official_title_or_position": "CLINICAL DIRECTOR",
        "authorized_official_telephone_number": "724-626-8420",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "PA",
            "license": "TO BE ASSIGNED",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "TO BE ASSIGNED",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Connellsville, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.