Provider Demographics
NPI:1578079448
Name:CONNOLLY, ARAN (SSP NCSP)
Entity Type:Individual
Prefix:MR
First Name:ARAN
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:SSP NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 HORATIO BLVD
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-1842
Mailing Address - Country:US
Mailing Address - Phone:847-353-5724
Mailing Address - Fax:
Practice Address - Street 1:200 HORATIO BLVD
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-1842
Practice Address - Country:US
Practice Address - Phone:847-353-5724
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1899073103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool