Provider Demographics
NPI:1770988719
Name:CONNELLY, SABRINA (LMHC)
Entity type:Individual
Prefix:
First Name:SABRINA
Middle Name:
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 SAMARA LAKES PKWY
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-1937
Mailing Address - Country:US
Mailing Address - Phone:904-625-3162
Mailing Address - Fax:904-456-0852
Practice Address - Street 1:260 PASEO REYES DR
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8462
Practice Address - Country:US
Practice Address - Phone:904-419-9189
Practice Address - Fax:904-456-0852
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12917101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
873173509-32095-0000OtherTRICARE EAST
FL12917Medicaid