MEDICARE: DR. AMY KATHRYN CONNERY PSY D, ABPP/CN

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
1	103T00000X	Psychologist	PSY19276	CA
2	103T00000X	Psychologist	62661702501	UT
3	103G00000X	Clinical Neuropsychologist	3447	CO

General Provider Information

NPI Number	:	1598832255
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMY KATHRYN CONNERY PSY D, ABPP/CN

Provider Business Mailing Address
First Line	:	PO BOX 925
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80306-0925
Country	:	US
Telephone Number	:	720-378-1224
Fax Number	:	720-210-9885

Provider Business Practice Location Address
First Line	:	954 NORTH ST
Second Line	:	SUITE 305
City	:	BOULDER
State	:	CO
Zip	:	80304-3419
Country	:	US
Telephone Number	:	720-378-1224
Fax Number	:	720-210-9885

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2006
Last Update Date	:	06/16/2010

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