Individual provider Active NPI

Margaret Connolly, PHD

  • Psychologist
  • Evansville, IN
National Provider Identifier
1467490698
Registry record updated Feb 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
20040779 Issued in IN
Practice address
3101 N Green River Rd
Suite 910
Evansville, IN 47715-1369
Phone
(812) 479-1916
Fax
(812) 479-5014
NPI assigned
Jun 2, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 29, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 20040779 IN Primary

Addresses

Primary practice location

3101 N Green River Rd
Suite 910
Evansville, IN 47715-1369

Mailing address

3101 N Green River Rd
Suite 910
Evansville, IN 47715-1369
Phone (812) 479-1916

Other identifiers 1

IdentifierTypeStateIssuer
000000267330OtherINANTHEM BC/BS PROVIDER NUM

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)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
20040779INMDPsychologist

Practice roles

OrganizationSpecialtyStatusNew patients
Luzio & Associates Behavioral Services, Inc. PastSince Jun 3, 2010 Accepting new patients
Luzio & Associates Behavioral Services, Inc. Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1204243200000",
    "number": "1467490698",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3101 N GREEN RIVER RD",
            "address_2": "SUITE 910",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477151369",
            "telephone_number": "812-479-1916",
            "fax_number": "812-479-5014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3101 N GREEN RIVER RD",
            "address_2": "SUITE 910",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477151369",
            "telephone_number": "812-479-1916",
            "fax_number": "812-479-5014"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNOLLY",
        "first_name": "MARGARET",
        "name_prefix": "Mrs.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-06-02",
        "last_updated": "2008-02-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20040779",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC/BS PROVIDER NUM",
            "identifier": "000000267330",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Evansville, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 29, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.