Provider Demographics
NPI:1003971573
Name:MCNEIL, CONNIE KAYE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:KAYE
Last Name:MCNEIL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7027 MONTGOMERY BLVD NE STE F
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1529
Mailing Address - Country:US
Mailing Address - Phone:505-880-0100
Mailing Address - Fax:505-880-0102
Practice Address - Street 1:7027 MONTGOMERY BLVD NE STE F
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1529
Practice Address - Country:US
Practice Address - Phone:505-880-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014435103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM91336309Medicaid
NYA400050161Medicare PIN
NY02145577Medicaid