Active NPI
Kevin J Connolly, PH.D.
- Clinical Psychologist
- Bloomfield, CT
National Provider Identifier
1336246925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 001144
- Practice address
- 34 Jerome Ave
Suite 301
Bloomfield, CT 06002-2463 - Phone
- (860) 242-3702
- Fax
- (860) 242-1964
- NPI assigned
- Sep 17, 2006
- Last updated
- Dec 26, 2024
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 001144 | CT | Primary |
Addresses
Primary practice location
34 Jerome Ave
Suite 301
Bloomfield, CT 06002-2463
Mailing address
34 Jerome Ave
Suite 301
Bloomfield, CT 06002-2463
Phone (860) 242-3702
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110708000004 | CT | Practitioner - Clinical Psychologist | 7719002377 | Practice locations: Bloomfield, CT |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 001144 | CT | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158451200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735171200000",
"number": "1336246925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "34 JEROME AVE",
"address_2": "SUITE 301",
"city": "BLOOMFIELD",
"state": "CT",
"postal_code": "060022463",
"telephone_number": "860-242-3702",
"fax_number": "860-242-1964"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "34 JEROME AVE",
"address_2": "SUITE 301",
"city": "BLOOMFIELD",
"state": "CT",
"postal_code": "060022463",
"telephone_number": "860-242-3702",
"fax_number": "860-242-1964"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "KEVIN",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-09-17",
"last_updated": "2024-12-26",
"certification_date": "2024-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "001144",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomfield, CT
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Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.