Provider Demographics
NPI:1730290776
Name:CONNELLY, MARGARET BARBARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:BARBARA
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 N BROADWAY
Mailing Address - Street 2:STE 1
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-2623
Mailing Address - Country:US
Mailing Address - Phone:845-358-6914
Mailing Address - Fax:845-358-5001
Practice Address - Street 1:56 N BROADWAY
Practice Address - Street 2:STE 1
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-2623
Practice Address - Country:US
Practice Address - Phone:845-358-6914
Practice Address - Fax:845-358-5001
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006917103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00797168Medicaid
NYV24561Medicare ID - Type Unspecified