Provider Demographics
NPI:1629287321
Name:CONNELL, PAM SR (LCSW, CASAC)
Entity Type:Individual
Prefix:MS
First Name:PAM
Middle Name:
Last Name:CONNELL
Suffix:SR
Gender:F
Credentials:LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200A HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-1534
Mailing Address - Country:US
Mailing Address - Phone:516-328-1717
Mailing Address - Fax:516-328-1627
Practice Address - Street 1:1200A HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-1534
Practice Address - Country:US
Practice Address - Phone:516-328-1717
Practice Address - Fax:516-328-1627
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0383231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01013818Medicaid
NY01013818Medicaid