Provider Demographics
NPI:1194099952
Name:CONNOLLY, ABIGAIL A (PHD)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:A
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ABIGAIL
Other - Middle Name:A
Other - Last Name:CONNOLLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:333 MCDONALD AVE APT 3L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11218-2272
Mailing Address - Country:US
Mailing Address - Phone:718-437-7494
Mailing Address - Fax:
Practice Address - Street 1:333 MCDONALD AVE APT 3L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11218-2272
Practice Address - Country:US
Practice Address - Phone:718-437-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool