Provider Demographics
NPI:1437546579
Name:BUONOMO, STACY IRENE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:STACY
Middle Name:IRENE
Last Name:BUONOMO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 BRAZIL LANE
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15909
Mailing Address - Country:US
Mailing Address - Phone:814-244-6748
Mailing Address - Fax:814-942-9500
Practice Address - Street 1:125 EMERYVILLE DR SUITE 230
Practice Address - Street 2:
Practice Address - City:CRANBERRY TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:16066
Practice Address - Country:US
Practice Address - Phone:724-609-5002
Practice Address - Fax:814-942-9500
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW130278104100000X
PACW0192831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1032264520001Medicaid