Provider Demographics
NPI:1720451214
Name:MASSEY-CONNOLLY, SUSAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:MASSEY-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:PO BOX 3995
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30302-3995
Mailing Address - Country:US
Mailing Address - Phone:404-413-6245
Mailing Address - Fax:404-413-6130
Practice Address - Street 1:140 DECATUR ST
Practice Address - Street 2:THE URBAN LIFE BUILDING 10TH FLOOR SUITE 1053
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30302-3995
Practice Address - Country:US
Practice Address - Phone:404-413-6245
Practice Address - Fax:404-413-6130
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA3832103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist