Provider Demographics
NPI:1972641306
Name:CONNOLLY, BETH DIANE (PSYD)
Entity type:Individual
Prefix:MRS
First Name:BETH
Middle Name:DIANE
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:MISS
Other - First Name:BETH
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:1 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03064-2716
Mailing Address - Country:US
Mailing Address - Phone:603-883-0005
Mailing Address - Fax:603-883-0007
Practice Address - Street 1:1 MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-2716
Practice Address - Country:US
Practice Address - Phone:603-883-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1212103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist