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NPI Code Detail

MEDICARE: CATHLEEN TERESA CONNOLLY PH.D.

MEDICARE: CATHLEEN TERESA CONNOLLY PH.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC1900XCounseling PsychologistPY7785FL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00754145OTHERFLRAILROAD MEDICARE PART B

General Provider Information

NPI Number : 1437307956
Entity Type Code : Individual
Provider Name (Legal Business Name) : CATHLEEN TERESA CONNOLLY PH.D.
Provider Business Mailing Address
First Line : PO BOX 748519
Second Line :
City : ATLANTA
State : GA
Zip : 30374-8519
Country : US
Telephone Number : 904-376-3800
Fax Number : 904-376-3998
Provider Business Practice Location Address
First Line : 1361 13TH AVE S STE 270
Second Line :
City : JACKSONVILLE BEACH
State : FL
Zip : 32250-3258
Country : US
Telephone Number : 904-376-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2008
Last Update Date : 03/04/2026

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