Provider Demographics
NPI:1659655595
Name:CONNELLY, EVELYN M (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EVELYN
Middle Name:M
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:405 ILLINOIS AVE UNIT 2C
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174-2963
Mailing Address - Country:US
Mailing Address - Phone:630-377-3535
Mailing Address - Fax:630-377-6703
Practice Address - Street 1:405 ILLINOIS AVE UNIT 2C
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2963
Practice Address - Country:US
Practice Address - Phone:630-377-3535
Practice Address - Fax:630-377-6703
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0179431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical