MEDICARE: JAMES WILLIAM CONNELLY PSY.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
1	103TC0700X	Clinical Psychologist	PSY 202425	ID

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841324332
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES WILLIAM CONNELLY PSY.D

Provider Business Mailing Address
First Line	:	13389 W BELLFLOWER DR
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83713-1345
Country	:	US
Telephone Number	:	208-939-0951
Fax Number	:

Provider Business Practice Location Address
First Line	:	2076 S EAGLE RD
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83642-6707
Country	:	US
Telephone Number	:	208-955-7333
Fax Number	:	208-955-7330

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	04/30/2013

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