Provider Demographics
NPI:1538303482
Name:PANDO-CONNOLLY, GEORGINA (LCADC)
Entity Type:Individual
Prefix:MRS
First Name:GEORGINA
Middle Name:
Last Name:PANDO-CONNOLLY
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 RUES LN
Mailing Address - Street 2:
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5699
Mailing Address - Country:US
Mailing Address - Phone:732-257-6100
Mailing Address - Fax:732-651-9834
Practice Address - Street 1:288 RUES LN
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5699
Practice Address - Country:US
Practice Address - Phone:732-257-6100
Practice Address - Fax:732-651-9834
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00078000101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)