Provider Demographics
NPI:1578502092
Name:CONNELLY, NORMA JEAN (MSW)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:JEAN
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 W POLAND RD
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:PA
Mailing Address - Zip Code:16112-2118
Mailing Address - Country:US
Mailing Address - Phone:330-884-1586
Mailing Address - Fax:330-743-1430
Practice Address - Street 1:740 W POLAND RD
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:PA
Practice Address - Zip Code:16112-2118
Practice Address - Country:US
Practice Address - Phone:330-884-1586
Practice Address - Fax:330-743-1430
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00074921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical