Staci June Connolly, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CW014460 Issued in PA

Practice address

639 Swedesford Rd
Malvern, PA 19355-1530

Phone

(610) 529-1579

NPI assigned

Feb 5, 2007

Last updated

Feb 24, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 PA

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

Specialty

Clinical Social Worker

Education

Other, 1998

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Cornerstone Counseling and Wellness LLCGroup PAC ID 9133664626, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Cornerstone Counseling and Wellness, LLC

  dba Cornerstone Therapy and Wellness

  • Mental Health Counselor
  • Malvern, PA
  • NPI 1750713889
  Medicare reassignment Care Compare group NPD Authorized official

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

{
    "created_epoch": "1170633600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1582502400000",
    "number": "1649319815",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 SWEDESFORD RD",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193551530",
            "telephone_number": "610-529-1579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "639 SWEDESFORD RD",
            "city": "MALVERN",
            "state": "PA",
            "postal_code": "193551530",
            "telephone_number": "610-529-1579"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "183 W Lancaster Ave",
            "address_purpose": "LOCATION",
            "city": "Paoli",
            "state": "PA",
            "postal_code": "193011740",
            "country_code": "US",
            "telephone_number": "484-527-0181",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "STACI",
        "middle_name": "JUNE",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-05",
        "last_updated": "2020-02-24",
        "certification_date": "2020-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "PA",
            "license": "CW014460",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Community Services of Devereux
• Compounding RX Apothecary
• Comprehensive Behavioral Health, LLC
• Julian Conejo Gutierrez
• Jessica W Connell, CRNP
• Dawn Connors, MSW, LCSW
• Jaclyn Conrad, M.S., NCC
• Nancy J Conway, LCSW
• Michelle Cooper, NURSE PRACTITIONER
• Linda Carman Copel, PHD

• Clinical Social Worker in Malvern, PA
• Providers in Malvern, PA by specialty
• Clinical Social Worker in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.