Provider Demographics
NPI:1265854996
Name:KARIN CONNELLY PHD PSYCHOLOGY COACHING PLLC
Entity Type:Organization
Organization Name:KARIN CONNELLY PHD PSYCHOLOGY COACHING PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KARIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:CONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-750-0476
Mailing Address - Street 1:1 COMMONS DR
Mailing Address - Street 2:
Mailing Address - City:LAKE KATRINE
Mailing Address - State:NY
Mailing Address - Zip Code:12449-5149
Mailing Address - Country:US
Mailing Address - Phone:845-750-0476
Mailing Address - Fax:845-336-4014
Practice Address - Street 1:1 COMMONS DR
Practice Address - Street 2:
Practice Address - City:LAKE KATRINE
Practice Address - State:NY
Practice Address - Zip Code:12449-5149
Practice Address - Country:US
Practice Address - Phone:845-750-0476
Practice Address - Fax:845-336-4014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-15
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012496103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty