Provider Demographics
NPI:1548800410
Name:CONNOLLY, ELIZABETH MARY (LPC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MARY
Last Name:CONNOLLY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2145
Mailing Address - Country:US
Mailing Address - Phone:201-341-0793
Mailing Address - Fax:
Practice Address - Street 1:402 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-1960
Practice Address - Country:US
Practice Address - Phone:732-635-9797
Practice Address - Fax:732-635-1711
Is Sole Proprietor?:No
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00536500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional