Individual provider Active NPI

Grace Connolly, LSW CDCA

  • Social Worker
  • Willoughby, OH
National Provider Identifier
1477264620
Registry record updated Mar 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Social WorkerTaxonomy code 104100000X
Practice address
38882 Mentor Ave
Willoughby, OH 44094-7875
Phone
(440) 578-8200
NPI assigned
Dec 8, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 3, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X S.1802996 OH
Addiction (Substance Use Disorder) Counselor 101YA0400X
Social Worker 104100000X Primary

Addresses

Primary practice location

38882 Mentor Ave
Willoughby, OH 44094-7875

Mailing address

7232 Justin Way
Mentor, OH 44060-4881
Phone (440) 578-8200

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20250402002808 OH Practitioner - Clinical Social Worker 7911420625 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
S.1802996OHMDCounselor

Practice roles

OrganizationSpecialtyStatusNew patients
Signature Health, Inc CurrentSince Feb 27, 2025 Accepting new patients
Signature Health Inc CurrentSince Feb 27, 2025 Accepting new patients
Signature Health, Inc. Current Accepting new patients

Locations

21100 Southgate Park Blvd
Maple Heights, OH 44137
Phone (216) 663-6100

7232 Justin Way
Mentor, OH 44060
Phone (440) 488-2855

38882 Mentor Ave
Willoughby, OH 44094

38876 Mentor Ave
Willoughby, OH 44094
Phone (440) 954-3333

Organizations & group practices 3

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": "1670457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740960000000",
    "number": "1477264620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7232 JUSTIN WAY",
            "city": "MENTOR",
            "state": "OH",
            "postal_code": "440604881",
            "telephone_number": "440-578-8200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38882 MENTOR AVE",
            "city": "WILLOUGHBY",
            "state": "OH",
            "postal_code": "440947875",
            "telephone_number": "440-578-8200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "GRACE",
        "credential": "LSW CDCA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-12-08",
        "last_updated": "2025-03-03",
        "certification_date": "2025-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "OH",
            "license": "S.1802996",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Willoughby, OH

Sources for this page

Verify at the official NPI Registry.