Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 11543 | MA |
Y | 103TC0700X | Clinical Psychologist | 11543 | MA |
NPI | 1003478843 |
---|---|
Provider Name | Dr. Eric Joseph Connors |
First Address | Charlestown, MA 02129-2025 |
Second Address | Charlestown, MA 02129-2025 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2019 |
Last Update Date | 12/08/2021 |