Provider Demographics
NPI:1427124346
Name:DAVIDSON-CONNELLY, LORNA JEAN (MED)
Entity type:Individual
Prefix:
First Name:LORNA
Middle Name:JEAN
Last Name:DAVIDSON-CONNELLY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:LORNA
Other - Middle Name:JD
Other - Last Name:CONNELLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MED
Mailing Address - Street 1:15 LEDGEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-3526
Mailing Address - Country:US
Mailing Address - Phone:781-245-9369
Mailing Address - Fax:
Practice Address - Street 1:27 CONGRESS ST
Practice Address - Street 2:SUITE 105
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-7309
Practice Address - Country:US
Practice Address - Phone:978-740-1510
Practice Address - Fax:781-935-7805
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA86101YA0400X
MA4208101YM0800X
MA354200101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool