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General NPI Number Information
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NPI Number | 1720451214
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Entity Type | Individual
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Provider Name | SUSAN MASSEY-CONNOLLY PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 11/05/2015
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Last Update Date | 11/05/2015
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Provider Practice Location Address
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Address Line | 140 DECATUR ST THE URBAN LIFE BUILDING 10TH FLOOR SUITE 1053
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City | ATLANTA
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State | GA
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Zip | 30302-3995
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Country | US
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Telephone | 404-413-6245
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Fax | 404-413-6130
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Provider Business Mailing Address
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Address Line | PO BOX 3995
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City | ATLANTA
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State | GA
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Zip | 30302-3995
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Country | US
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Telephone | 404-413-6245
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Fax | 404-413-6130
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3832
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 3832
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License Number State | GA
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