Healthcare Provider Details

I. General information

NPI: 1104771385
Provider Name (Legal Business Name): CONNOR JAMES HEALY PHD
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

928 BROADWAY STE 1105
NEW YORK NY
10010-8111
US

IV. Provider business mailing address

928 BROADWAY STE 1105
NEW YORK NY
10010-8111
US

V. Phone/Fax

Practice location:
  • Phone: 347-450-3794
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP136860
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: