Provider Demographics
NPI:1700951019
Name:CONNELL, JOAN M (LCSW, BCD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:CONNELL
Suffix:
Gender:F
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 POST AVE
Mailing Address - Street 2:SUITE LL1
Mailing Address - City:WESTBURY
Mailing Address - State:NY
Mailing Address - Zip Code:11590-2257
Mailing Address - Country:US
Mailing Address - Phone:516-338-6940
Mailing Address - Fax:516-338-7878
Practice Address - Street 1:320 POST AVE
Practice Address - Street 2:SUITE LL1
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-2257
Practice Address - Country:US
Practice Address - Phone:516-338-6940
Practice Address - Fax:516-338-7878
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR022421-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1938Medicare ID - Type Unspecified