Active NPI
Erin Kelly Connell, MS
- Behavior Analyst
- Medford, NY
National Provider Identifier
1215299250
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 000311-1
- Practice address
- 164 Fordham Ave
Medford, NY 11763-3132 - Phone
- (631) 617-3583
- NPI assigned
- Jun 14, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | NY | ||
| Behavior Analyst | 103K00000X | 000311-1 | NY | Primary |
Addresses
Primary practice location
164 Fordham Ave
Medford, NY 11763-3132
Mailing address
164 Fordham Ave
Medford, NY 11763-3132
Phone (631) 617-3583
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000311-1 | NY | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1339632000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1467158400000",
"number": "1215299250",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "164 FORDHAM AVE",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117633132",
"telephone_number": "631-617-3583"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "164 FORDHAM AVE",
"city": "MEDFORD",
"state": "NY",
"postal_code": "117633132",
"telephone_number": "631-617-3583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELL",
"first_name": "ERIN",
"middle_name": "KELLY",
"name_prefix": "Mrs.",
"credential": "MS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-14",
"last_updated": "2016-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NY",
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NY",
"license": "000311-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Medford, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.