Provider Demographics
NPI:1942405345
Name:CONNELLY, MICHAEL JOHN (LPC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 WABASH ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15220-5436
Mailing Address - Country:US
Mailing Address - Phone:412-894-8222
Mailing Address - Fax:412-223-2422
Practice Address - Street 1:22 WABASH ST
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-5436
Practice Address - Country:US
Practice Address - Phone:412-894-8222
Practice Address - Fax:412-223-2422
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004578101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA202089OtherNCC NUMBER
PAPC004578OtherLPC LICESNSE NUMBER