Provider Demographics
NPI:1659021954
Name:MCDONNELL, GLYNNIS A (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLYNNIS
Middle Name:A
Last Name:MCDONNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:GLYNNIS
Other - Middle Name:
Other - Last Name:O'SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:#1086
Mailing Address - Street 2:1280 LEXINGTON AVE STE 2
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028
Mailing Address - Country:US
Mailing Address - Phone:917-512-9496
Mailing Address - Fax:
Practice Address - Street 1:#1086
Practice Address - Street 2:1280 LEXINGTON AVE STE 2
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028
Practice Address - Country:US
Practice Address - Phone:917-512-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-28
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024809103TC0700X, 103TC2200X
NJ35SI00707200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical