Provider Demographics
NPI:1164554564
Name:CONNERAN, JAMES MARK (PH D)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:CONNERAN
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 MAYWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1026
Mailing Address - Country:US
Mailing Address - Phone:732-536-3919
Mailing Address - Fax:732-536-7569
Practice Address - Street 1:220 RUES LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816
Practice Address - Country:US
Practice Address - Phone:732-257-7715
Practice Address - Fax:732-613-9757
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2010-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100435600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist