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General NPI Number Information
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NPI Number | 1730406372
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Entity Type | Organization
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Legal Business Name | VIRGINIA CONNELLY, LCSW, LLC
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Dates
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Enumeration Date | 04/21/2010
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Last Update Date | 04/21/2010
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Provider Practice Location Address
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Address Line | 89 W RIDGEWOOD AVE
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3142
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Country | US
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Telephone | 201-300-6425
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Fax |
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Provider Business Mailing Address
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Address Line | 0014 WHITEHALL ST
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City | FAIR LAWN
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State | NJ
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Zip | 07410-2913
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Country | US
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Telephone | 201-300-6425
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | VIRGINIA MICKOLAJCZYK
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Credential | LCSW
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Telephone | 201-300-6425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC00575100
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License Number State | NJ
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