Provider Demographics
NPI:1942405345
Name:CONNELLY, MICHAEL JOHN (LPC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:CONNELLY
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 SCHAUFFLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST HOMESTEAD
Mailing Address - State:PA
Mailing Address - Zip Code:15120-1345
Mailing Address - Country:US
Mailing Address - Phone:412-999-7745
Mailing Address - Fax:412-939-4010
Practice Address - Street 1:1406 SCHAUFFLER DR
Practice Address - Street 2:
Practice Address - City:WEST HOMESTEAD
Practice Address - State:PA
Practice Address - Zip Code:15120-1345
Practice Address - Country:US
Practice Address - Phone:412-999-7745
Practice Address - Fax:412-939-4010
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004578101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC004578OtherLPC LICESNSE NUMBER
PA202089OtherNCC NUMBER