Provider Demographics
NPI:1972872356
Name:CONNOLLY COUNSELING
Entity type:Organization
Organization Name:CONNOLLY COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEO
Authorized Official - Last Name:CONNOLLY
Authorized Official - Suffix:JR
Authorized Official - Credentials:PSYD
Authorized Official - Phone:626-768-1083
Mailing Address - Street 1:PO BOX 1196
Mailing Address - Street 2:SUITE 301
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-1196
Mailing Address - Country:US
Mailing Address - Phone:626-768-1083
Mailing Address - Fax:
Practice Address - Street 1:1499 HUNTINGTON DR STE 301
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-5446
Practice Address - Country:US
Practice Address - Phone:626-768-1083
Practice Address - Fax:626-270-7002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23835103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty