Provider Demographics
NPI:1316046865
Name:CONNOLLY, MARY FRANCES (MA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:FRANCES
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 BISHOP WALSH RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1903
Mailing Address - Country:US
Mailing Address - Phone:301-759-4501
Mailing Address - Fax:
Practice Address - Street 1:278 NORTH HIGH ST.
Practice Address - Street 2:SUITE 1
Practice Address - City:ROMNEY
Practice Address - State:WV
Practice Address - Zip Code:26757
Practice Address - Country:US
Practice Address - Phone:304-822-3429
Practice Address - Fax:304-822-7225
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV924103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810006317Medicaid