Provider Demographics
NPI:1922201532
Name:CONNELL, JANE MARIE (MS, LCPC)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:MARIE
Last Name:CONNELL
Suffix:
Gender:F
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 N HOWARD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5909
Mailing Address - Country:US
Mailing Address - Phone:443-438-6742
Mailing Address - Fax:443-773-5624
Practice Address - Street 1:31 BALTIMORE ST STE 109
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3091
Practice Address - Country:US
Practice Address - Phone:443-301-8774
Practice Address - Fax:410-630-6300
Is Sole Proprietor?:No
Enumeration Date:2007-06-10
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC2197101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional