Provider Demographics
NPI:1700104791
Name:CONNOLLY, KATHERINE M (PSYD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:M
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:93 OLD YORK RD
Mailing Address - Street 2:
Mailing Address - City:JENKINTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19046-3925
Mailing Address - Country:US
Mailing Address - Phone:215-885-3337
Mailing Address - Fax:215-885-3090
Practice Address - Street 1:93 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:JENKINTOWN
Practice Address - State:PA
Practice Address - Zip Code:19046-3925
Practice Address - Country:US
Practice Address - Phone:215-885-3337
Practice Address - Fax:215-885-3090
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS106746103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist