Provider Demographics
NPI:1356393052
Name:CONNELLY, KARIN (PHD)
Entity type:Individual
Prefix:
First Name:KARIN
Middle Name:
Last Name:CONNELLY
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:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:FRANKLINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27248-0204
Mailing Address - Country:US
Mailing Address - Phone:845-750-0476
Mailing Address - Fax:
Practice Address - Street 1:9 AVA MARIA DR
Practice Address - Street 2:
Practice Address - City:PHOENICIA
Practice Address - State:NY
Practice Address - Zip Code:12464-5102
Practice Address - Country:US
Practice Address - Phone:845-750-0476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3063103TC0700X
NY012496103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00354316Medicaid