Provider Demographics
NPI:1447367719
Name:CONNELLY, JUDITH BROWN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:BROWN
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 HAWKS LNDG
Mailing Address - Street 2:
Mailing Address - City:WEAVERVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28787-8111
Mailing Address - Country:US
Mailing Address - Phone:828-484-9041
Mailing Address - Fax:
Practice Address - Street 1:1100 TUNNEL ROAD
Practice Address - Street 2:CHARLES GEORGE VAMC
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28805
Practice Address - Country:US
Practice Address - Phone:828-299-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 7096103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical