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General NPI Number Information
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NPI Number | 1548665052
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Entity Type | Individual
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Provider Name | MICHAEL CONNELL
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Gender | Male
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Dates
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Enumeration Date | 10/27/2014
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Last Update Date | 04/01/2022
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Provider Practice Location Address
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Address Line | 233 MAIN ST
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City | NEW BRITAIN
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State | CT
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Zip | 06051-4204
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Country | US
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Telephone | 617-459-5519
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Fax |
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Provider Business Mailing Address
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Address Line | 85 PINE BROOK TER APT 2
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City | BRISTOL
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State | CT
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Zip | 06010-7428
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Country | US
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Telephone | 617-459-5519
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 3756
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 46.003756
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License Number State | CT
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