Active NPI
John T Connelly Jr., PH.D.LPC.LRC
- Cognitive & Behavioral Psychologist
- Pennsauken, NJ
National Provider Identifier
1710149042
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Cognitive & Behavioral Psychologist
- License
- PC912,RC1012
- Practice address
- 6500 Madison Ave
Suite 5B
Pennsauken, NJ 08109-2766 - Phone
- (856) 488-6285
- Fax
- (856) 663-4743
- NPI assigned
- Jun 27, 2008
- 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 |
|---|---|---|---|---|
| Cognitive & Behavioral Psychologist | 103TB0200X | PC912,RC1012 | NJ | Primary |
Addresses
Primary practice location
6500 Madison Ave
Suite 5B
Pennsauken, NJ 08109-2766
Mailing address
6500 Madison Ave
Suite 5B
Pennsauken, NJ 08109-2766
Phone (856) 488-6285
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 |
|---|---|---|---|
| PC912,RC1012 | NJ | MD | Cognitive & Behavioral Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1214524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1215388800000",
"number": "1710149042",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6500 MADISON AVE",
"address_2": "SUITE 5B",
"city": "PENNSAUKEN",
"state": "NJ",
"postal_code": "081092766",
"telephone_number": "856-488-6285",
"fax_number": "856-663-4743"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6500 MADISON AVE",
"address_2": "SUITE 5B",
"city": "PENNSAUKEN",
"state": "NJ",
"postal_code": "081092766",
"telephone_number": "856-488-6285",
"fax_number": "856-663-4743"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELLY",
"first_name": "JOHN",
"middle_name": "T",
"name_prefix": "Dr.",
"name_suffix": "Jr.",
"credential": "PH.D.LPC.LRC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2008-06-27",
"last_updated": "2008-07-07",
"status": "A"
},
"taxonomies": [
{
"code": "103TB0200X",
"taxonomy_group": "",
"desc": "Psychologist, Cognitive & Behavioral",
"state": "NJ",
"license": "PC912,RC1012",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pennsauken, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 7, 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.