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NPI Code Detail

MEDICARE: JOSEPH THOMAS CONNELLY

MEDICARE: JOSEPH THOMAS CONNELLY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103T00000XPsychologistPS003268LPA
2103TA0400XAddiction (Substance Use Disorder) PsychologistPS003268LPA
3106H00000XMarriage & Family TherapistPS003268LPA

General Provider Information

NPI Number : 1205001971
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH THOMAS CONNELLY
Provider Business Mailing Address
First Line : 1414 UNRUH AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19111-4910
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1414 UNRUH AVE
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19111-4910
Country : US
Telephone Number : 215-742-0554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/24/2008
Last Update Date : 04/24/2008

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Directions to “ JOSEPH THOMAS CONNELLY ” Practice Location

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