Provider Demographics
NPI:1528302528
Name:CONNOLLY, THOMAS JOHN (MSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOHN
Last Name:CONNOLLY
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-6002
Mailing Address - Country:US
Mailing Address - Phone:978-282-1000
Mailing Address - Fax:978-283-0523
Practice Address - Street 1:180 MAIN ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-6002
Practice Address - Country:US
Practice Address - Phone:978-282-1000
Practice Address - Fax:978-283-0523
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst