Provider Demographics
NPI:1033689989
Name:CONNELLY, REBECCA (MFT)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:CONNELLY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06519-1233
Mailing Address - Country:US
Mailing Address - Phone:203-503-3000
Mailing Address - Fax:
Practice Address - Street 1:285 MAIN STREET
Practice Address - Street 2:CS-HHC WHCCS
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-7307
Practice Address - Country:US
Practice Address - Phone:203-503-3409
Practice Address - Fax:203-503-3431
Is Sole Proprietor?:No
Enumeration Date:2018-12-04
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2489106H00000X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist