Provider Demographics
NPI:1609218866
Name:KELLY O'CONNELL-SEAGRAVES
Entity Type:Organization
Organization Name:KELLY O'CONNELL-SEAGRAVES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:O'CONNELL-SEAGRAVES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:860-371-5668
Mailing Address - Street 1:122A NAUBUC AVE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-4246
Mailing Address - Country:US
Mailing Address - Phone:860-371-5668
Mailing Address - Fax:
Practice Address - Street 1:122A NAUBUC AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4246
Practice Address - Country:US
Practice Address - Phone:860-371-5668
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002322251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health