Provider Demographics
NPI:1336246925
Name:CONNOLLY, KEVIN J (PHD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:J
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:34 JEROME AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BLOOMFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06002-2463
Mailing Address - Country:US
Mailing Address - Phone:860-242-3702
Mailing Address - Fax:860-242-1964
Practice Address - Street 1:34 JEROME AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:BLOOMFIELD
Practice Address - State:CT
Practice Address - Zip Code:06002-2463
Practice Address - Country:US
Practice Address - Phone:860-242-3702
Practice Address - Fax:860-242-1964
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2024-12-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT001144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060001144Medicare UPIN