Provider Demographics
NPI:1215141437
Name:CONNOLLY, KATHRYN SANDERS (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:SANDERS
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:KATHRYN
Other - Middle Name:AMELIA
Other - Last Name:SANDERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:BALTIC
Mailing Address - State:CT
Mailing Address - Zip Code:06330-0351
Mailing Address - Country:US
Mailing Address - Phone:203-815-8725
Mailing Address - Fax:
Practice Address - Street 1:1320 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-1940
Practice Address - Country:US
Practice Address - Phone:203-932-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017131103TC0700X
CT003015103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical