Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS003268L | PA |
Y | 103T00000X | Psychologist | PS003268L | PA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PS003268L | PA |
NPI | 1205001971 |
---|---|
Provider Name | Joseph Thomas Connelly |
First Address | Philadelphia, PA 19111-4910 |
Second Address | Philadelphia, PA 19111-4910 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2008 |
Last Update Date | 24/04/2008 |