Provider Demographics
NPI:1801045992
Name:CONNELLY, DENISE MARIE (LCSW-C; CAC-AD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:MARIE
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:LCSW-C; CAC-AD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13218 BROOKLANE DR
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21742-1435
Mailing Address - Country:US
Mailing Address - Phone:301-733-0330
Mailing Address - Fax:301-733-4038
Practice Address - Street 1:5301 BUCKEYSTOWN PIKE
Practice Address - Street 2:SUITE170
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-8370
Practice Address - Country:US
Practice Address - Phone:301-733-0330
Practice Address - Fax:301-733-4038
Is Sole Proprietor?:No
Enumeration Date:2008-09-12
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC0669101YA0400X
MD109151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)