Provider Demographics
NPI:1508168386
Name:CONNEELY, CIRSTIN
Entity Type:Individual
Prefix:
First Name:CIRSTIN
Middle Name:
Last Name:CONNEELY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CIRSTIN
Other - Middle Name:
Other - Last Name:CONNORS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:77 EASTERN PKWY
Mailing Address - Street 2:APT. 3A
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-5939
Mailing Address - Country:US
Mailing Address - Phone:718-622-0469
Mailing Address - Fax:
Practice Address - Street 1:34 PLAZA ST E
Practice Address - Street 2:SUITE 109
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11238-5038
Practice Address - Country:US
Practice Address - Phone:718-536-6040
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0767061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical