Active NPI
Jacob Connolly, PSY.D.
- Psychologist
- Davie, FL
National Provider Identifier
1629492830
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PY 9211
- Practice address
- 1839 SW 81St Ter
Davie, FL 33324-4643 - Phone
- (754) 800-2003
- NPI assigned
- Feb 7, 2014
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PY 9211 | FL | Primary |
Addresses
Primary practice location
1839 SW 81St Ter
Davie, FL 33324-4643
Mailing address
1839 SW 81St Ter
Davie, FL 33324-4643
Phone (754) 800-2003
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PY 9211 | FL | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1391731200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421107200000",
"number": "1629492830",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1839 SW 81ST TER",
"city": "DAVIE",
"state": "FL",
"postal_code": "333244643",
"telephone_number": "754-800-2003"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1839 SW 81ST TER",
"city": "DAVIE",
"state": "FL",
"postal_code": "333244643",
"telephone_number": "754-800-2003"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNOLLY",
"first_name": "JACOB",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-02-07",
"last_updated": "2015-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "FL",
"license": "PY 9211",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.