Provider Demographics
NPI:1376316232
Name:CONNOLLY, KATHERINE (PSYD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:CONNOLLY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:109 N 12TH ST STE 701
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11249-1002
Mailing Address - Country:US
Mailing Address - Phone:347-765-0904
Mailing Address - Fax:
Practice Address - Street 1:109 N 12TH ST STE 701
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11249-1002
Practice Address - Country:US
Practice Address - Phone:347-765-0904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-02
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY68-P133164-01103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty