Healthcare Provider Details

I. General information

NPI: 1891853834
Provider Name (Legal Business Name): PATRICK EUGENE CONNEALY LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7173 HARP STRING
COLUMBIA MD
21045-5247
US

IV. Provider business mailing address

7173 HARP STRING
COLUMBIA MD
21045-5247
US

V. Phone/Fax

Practice location:
  • Phone: 301-767-5688
  • Fax: 240-777-4806
Mailing address:
  • Phone: 301-767-5688
  • Fax: 240-777-4806

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06235
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: