Provider Demographics
NPI:1376808345
Name:CONNELLY, WENDY LEE (MS LMHC)
Entity Type:Individual
Prefix:MS
First Name:WENDY
Middle Name:LEE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MS LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 VLIET BLVD
Mailing Address - Street 2:
Mailing Address - City:COHOES
Mailing Address - State:NY
Mailing Address - Zip Code:12047-2019
Mailing Address - Country:US
Mailing Address - Phone:518-237-4263
Mailing Address - Fax:518-238-1036
Practice Address - Street 1:405 VLIET BLVD
Practice Address - Street 2:
Practice Address - City:COHOES
Practice Address - State:NY
Practice Address - Zip Code:12047-2019
Practice Address - Country:US
Practice Address - Phone:518-237-4263
Practice Address - Fax:518-238-1036
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY18 005181101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional