Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1041C0700X | Clinical Social Worker | 0 | |
Y | 1041C0700X | Clinical Social Worker | 096820 | NY |
NPI | 1003216490 |
---|---|
Provider Name | Marissa Leah Connelly |
First Address | Brooklyn, NY 11237-8042 |
Second Address | Brooklyn, NY 11237-8042 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2014 |
Last Update Date | 30/11/2017 |