NPIMap

Individual provider Active NPI

Avery Connolly

  • Professional Counselor
  • Berwyn, PA
National Provider Identifier
1407313653
Registry record updated Feb 25, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Professional CounselorTaxonomy code 101YP2500X
License
PC010411 Issued in PA
Practice address
95 Howellville Rd
Berwyn, PA 19312-1307
Phone
(610) 647-1431
NPI assigned
Feb 25, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X PC010411 PA Primary

Addresses

Primary practice location

95 Howellville Rd
Berwyn, PA 19312-1307

Mailing address

95 Howellville Rd
Berwyn, PA 19312-1307
Phone (610) 647-1431

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
PC010411PAMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Daemion Counseling Center, Inc. Past Accepting new patients
Daemion Counseling Center Past Accepting new patients

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": "1551052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1551052800000",
    "number": "1407313653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 HOWELLVILLE RD",
            "city": "BERWYN",
            "state": "PA",
            "postal_code": "193121307",
            "telephone_number": "610-647-1431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 HOWELLVILLE RD",
            "city": "BERWYN",
            "state": "PA",
            "postal_code": "193121307",
            "telephone_number": "610-647-1431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "AVERY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-25",
        "last_updated": "2019-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "PA",
            "license": "PC010411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Berwyn, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2019; 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.