Provider Demographics
NPI:1497471353
Name:CONNELL, TANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TANA
Middle Name:
Last Name:CONNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BUCKEYE LN
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-5248
Mailing Address - Country:US
Mailing Address - Phone:518-360-8058
Mailing Address - Fax:
Practice Address - Street 1:112 BUCKEYE LN
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-5248
Practice Address - Country:US
Practice Address - Phone:518-360-8058
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-12
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor