Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1700328432 |
---|---|
Provider Name | Jeremy Paul Connolly |
First Address | New Orleans, LA 70115-2800 |
Second Address | New Orleans, LA 70119-6447 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2016 |
Last Update Date | 11/11/2016 |