Carly Petronella

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14006 Issued in CT

Practice address

75 West St
Danbury, CT 06810-6528

Phone

(203) 748-5689

NPI assigned

Feb 22, 2022

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

Medicare fee-for-service enrollment

Enrolled in CT

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: carly.petronella.1@28623.direct.athenahealth.com

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.

• Optum Behavioral Care of Connecticut, P.C.

  • Counseling Psychologist
  • Plantsville, CT
  • NPI 1164203238
  Medicare reassignment NPD
• Optum Behavioral Care of Connecticut, P.C.

  • Clinical Social Worker
  • Providence, RI
  • NPI 1730972944
  NPD

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

{
    "created_epoch": "1645488000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1740700800000",
    "number": "1558017293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "75 WEST ST",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068106528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "75 WEST ST",
            "city": "DANBURY",
            "state": "CT",
            "postal_code": "068106528",
            "telephone_number": "203-748-5689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRONELLA",
        "first_name": "CARLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-22",
        "last_updated": "2025-02-28",
        "certification_date": "2025-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CT",
            "license": "14006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Valerie Perry, LMSW
• Brandon Pervis Sr., APRN, FNP-C
• Jill A Peterson
• Mary A. C. Petrellese, BSW
• Jane Veronica Petroff, M.D.
• Philip Petrosky
• Janette Petrovich, PTA
• John Pezzimenti, M.D.
• Anthony Thanh Phan
• Johnny Minh Phan

• Clinical Social Worker in Danbury, CT
• Providers in Danbury, CT by specialty
• Clinical Social Worker in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.