Healthcare Provider Details

I. General information

NPI: 1053748434
Provider Name (Legal Business Name): JANET BARBARA CONNOLLY LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2013
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 LITTLE NECK WAY
MARSTONS MILLS MA
02648-1819
US

IV. Provider business mailing address

20 LITTLE NECK WAY
MARSTONS MILLS MA
02648-1819
US

V. Phone/Fax

Practice location:
  • Phone: 508-274-9550
  • Fax:
Mailing address:
  • Phone: 508-274-9550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1570
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: