Provider Demographics
NPI:1033224423
Name:CONNOLLY, SUZANNE MAE (LCSW MSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:MAE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PAYNE PLACE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SEDONA
Mailing Address - State:AZ
Mailing Address - Zip Code:86336-4536
Mailing Address - Country:US
Mailing Address - Phone:928-282-2627
Mailing Address - Fax:928-282-0121
Practice Address - Street 1:70 PAYNE PLACE
Practice Address - Street 2:SUITE 6
Practice Address - City:SEDONA
Practice Address - State:AZ
Practice Address - Zip Code:86336-4536
Practice Address - Country:US
Practice Address - Phone:928-282-2627
Practice Address - Fax:928-282-0121
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-1454101YM0800X
AZLMFT0145106H00000X
AZLISAC0022101YA0400X
AZLSSW14541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLMFT-0145OtherSTATE LICENSE
AZLISAC-0022OtherSTATE LICENSURE
AZLCSW-1454OtherSTATE LICENSE
AZLCSW-1454OtherSTATE LICENSE
AZLMFT-0145OtherSTATE LICENSE