Provider Demographics
NPI:1073840542
Name:CONNELLY, DOUGLAS P (CAC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:P
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 GRIGGS ST
Mailing Address - Street 2:MORRIS FOUNDATION, INC-THERAPEUTIC CENTER
Mailing Address - City:WATERBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06704-3110
Mailing Address - Country:US
Mailing Address - Phone:203-574-1419
Mailing Address - Fax:203-578-4180
Practice Address - Street 1:142 GRIGGS ST
Practice Address - Street 2:MORRIS FOUNDATION, INC-THERAPEUTIC CENTER
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06704-3110
Practice Address - Country:US
Practice Address - Phone:203-574-1419
Practice Address - Fax:203-578-4180
Is Sole Proprietor?:No
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional