Healthcare Provider Details

I. General information

NPI: 1881519965
Provider Name (Legal Business Name): MEGAN MARY CONNOLLY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924 ROUTE 35 STE 10B
WALL TOWNSHIP NJ
07719-3555
US

IV. Provider business mailing address

4 HARMON DR
TINTON FALLS NJ
07724-3343
US

V. Phone/Fax

Practice location:
  • Phone: 732-829-7377
  • Fax:
Mailing address:
  • Phone: 908-601-7752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC01295800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: