Provider Demographics
NPI:1659402691
Name:CONNELLY, PATRICK IGNATIUS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:IGNATIUS
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:08904-2548
Mailing Address - Country:US
Mailing Address - Phone:732-241-2154
Mailing Address - Fax:732-339-9138
Practice Address - Street 1:85 RARITAN AVE STE 400
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2439
Practice Address - Country:US
Practice Address - Phone:732-241-2154
Practice Address - Fax:732-339-9138
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI003571103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical