Provider Demographics
NPI:1861826000
Name:CONNOR, COLIN JOHN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:COLIN
Middle Name:JOHN
Last Name:CONNOR
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 1:300 W MAIN ST BLDG A
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-2132
Mailing Address - Country:US
Mailing Address - Phone:508-834-8878
Mailing Address - Fax:508-804-7172
Practice Address - Street 1:300 W MAIN ST BLDG A
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-2132
Practice Address - Country:US
Practice Address - Phone:508-834-8878
Practice Address - Fax:508-804-7172
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-23
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical