Stacy Lynn Cannavino, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1779893 Issued in NY

Practice address

104 Water St
Athens, PA 18810-1002

Phone

(570) 423-0365

NPI assigned

Nov 2, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Mindful Counseling and Mental Wellness Center, LLC

  • Mental Health Counselor
  • Athens, PA
  • NPI 1649132390
  NPD Authorized official
• Family Services of Chemung County, Inc.

  • Counselor
  • Elmira, NY
  • NPI 1619922432
  NPD (past)

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

{
    "created_epoch": "1446422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661472000000",
    "number": "1457724361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 WATER ST",
            "city": "ATHENS",
            "state": "PA",
            "postal_code": "188101002",
            "telephone_number": "570-423-0365"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 WATER ST",
            "city": "ATHENS",
            "state": "PA",
            "postal_code": "188101002",
            "telephone_number": "570-423-0365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CANNAVINO",
        "first_name": "STACY",
        "middle_name": "LYNN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-11-02",
        "last_updated": "2022-08-26",
        "certification_date": "2022-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "1779893",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Attuned Counseling and Trauma Therapy, LLC
• Joan Louise Ballenstedt, RN
• Chad Brian Benninger
• Nathaniel Brennan Callear, DC
• Kathryn Marie Canavan, MS OTR/L
• Cayv Cares
• Center for Effectiveness Inc
• Bradley Crum
• Sarah Dekay, LSW
• Miriam M Dewing, MSPT

• All providers in Athens, PA
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.