Provider Demographics
NPI:1245446558
Name:CONNELL, TAMMY JO (PHD)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:JO
Last Name:CONNELL
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:4210 BEAR CREEK RD
Mailing Address - Street 2:350
Mailing Address - City:FAIRVIEW
Mailing Address - State:PA
Mailing Address - Zip Code:16415-2017
Mailing Address - Country:US
Mailing Address - Phone:814-572-5549
Mailing Address - Fax:
Practice Address - Street 1:3910 CAUGHEY RD
Practice Address - Street 2:SUITE T-230
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4096
Practice Address - Country:US
Practice Address - Phone:814-838-3227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2025-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007430-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA5151316Medicare UPIN
PA000515444Medicare UPIN