MEDICARE: MS. MARYANN BLAKE CONNOLLY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	CW017498	PA

General Provider Information

NPI Number	:	1699146704
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARYANN BLAKE CONNOLLY LCSW

Provider Business Mailing Address
First Line	:	321 S 20TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6533
Country	:	US
Telephone Number	:	215-805-6571
Fax Number	:

Provider Business Practice Location Address
First Line	:	321 S 20TH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-6533
Country	:	US
Telephone Number	:	215-805-6571
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/14/2015
Last Update Date	:	10/14/2015

Similar Medicare Providers

1578591350 — MS. ELLEN VICKY WEISBERG M.A.
Practice Location Address:

325 S 20TH ST
PHILADELPHIA, PA
19103-6533

Practice Phone: 215-985-1947
Practice Fax: 215-985-3633

1457384943 — ELLEN WEISBERG
Practice Location Address:

325 S 20TH ST
PHILA, PA
19103-6533

Practice Phone: 215-985-1947
Practice Fax: 215-985-3633

1538109590 — DR. KRYSTAL T NGUYEN OD
Practice Location Address:

6533 ROOSEVELT BLVD
PHILADELPHIA, PA
19149

Practice Phone: 215-744-6727
Practice Fax: 215-744-1622

1609806777 — KRYSTAL VISION CENTER INC
Practice Location Address:

6533 ROOSEVELT BLVD
PHILADELPHIA, PA
19149-2918

Practice Phone: 215-744-6727
Practice Fax:

1710402748 — DANIEL ERMILUS
Practice Location Address:

6533 LINMORE AVE
PHILADELPHIA, PA
19142

Practice Phone: 267-721-5104
Practice Fax:

1396430252 — BRIGGS AT HOME HEALTH CARE LLC
Practice Location Address:

6533 CUTLER ST
PHILADELPHIA, PA
19126-3504

Practice Phone: 215-224-1245
Practice Fax: 215-224-1245

Directions to “ MS. MARYANN BLAKE CONNOLLY LCSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.