Provider Demographics
NPI:1659074623
Name:NICOLE CONNOLLY PH.D., PSYCHOLOGIST, A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:NICOLE CONNOLLY PH.D., PSYCHOLOGIST, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:661-430-9300
Mailing Address - Street 1:29565 SEQUOIA RD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-6243
Mailing Address - Country:US
Mailing Address - Phone:310-613-3588
Mailing Address - Fax:
Practice Address - Street 1:25050 PEACHLAND AVE STE 250
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-5755
Practice Address - Country:US
Practice Address - Phone:661-430-9300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty