Provider Demographics
NPI:1497764997
Name:CONNELL, MICHAEL P (CAGS,MA,LMHC,LCDP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:P
Last Name:CONNELL
Suffix:
Gender:M
Credentials:CAGS,MA,LMHC,LCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 CARRIAGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1419
Mailing Address - Country:US
Mailing Address - Phone:401-741-7755
Mailing Address - Fax:
Practice Address - Street 1:1130 TEN ROD RD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-4161
Practice Address - Country:US
Practice Address - Phone:401-741-7755
Practice Address - Fax:401-267-0105
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMHC00403101YM0800X
RI00228101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI11854367OtherCAQH