Provider Demographics
NPI:1427779347
Name:CONNOLLY, JUSTINE CHERI (PHD)
Entity type:Individual
Prefix:DR
First Name:JUSTINE
Middle Name:CHERI
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 DREAM OAK PL APT 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-3388
Mailing Address - Country:US
Mailing Address - Phone:407-883-3796
Mailing Address - Fax:
Practice Address - Street 1:3961 DREAM OAK PL APT 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-3388
Practice Address - Country:US
Practice Address - Phone:407-883-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
FL1347061103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool