Individual
MS. MARY CONNOLLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
92 EVERGREEN ST, STATEN ISLAND, NY 10308-1812
(718) 344-4981
Mailing address
92 EVERGREEN ST, STATEN ISLAND, NY 10308-1812
(718) 344-4981
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
Primary
6072764
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6072764
STATE CERTIFICATATE LMSW
NY
Enumeration date
10/22/2009
Last updated
10/22/2009
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