Provider Demographics
NPI:1437954872
Name:CONNELL, WILLIAM DANIEL III
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:DANIEL
Last Name:CONNELL
Suffix:III
Gender:
Credentials:
Other - Prefix:
Other - First Name:LIAM
Other - Middle Name:DANIEL
Other - Last Name:CONNELL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:350 FAIRWAY DRIVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33441
Mailing Address - Country:US
Mailing Address - Phone:877-418-2978
Mailing Address - Fax:866-500-2186
Practice Address - Street 1:10 DORRANCE STREET
Practice Address - Street 2:STE 700
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903
Practice Address - Country:US
Practice Address - Phone:877-418-2978
Practice Address - Fax:866-500-2186
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician