Active NPI
Dyan Elizabeth Connelly, PHD
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1790554632
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY34498
- Practice address
- 11301 Wilshire Blvd
BLDG 401, RM B131
Los Angeles, CA 90073 - Phone
- (310) 478-3711
- NPI assigned
- Dec 20, 2023
- Sex
- Female
- 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 | PSY34498 | CA | Primary |
Addresses
Primary practice location
11301 Wilshire Blvd
BLDG 401, RM B131
Los Angeles, CA 90073
Mailing address
11301 Wilshire Blvd
BLDG 401, RM B131
Los Angeles, CA 90073
Phone (310) 478-3711
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY34498 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1703030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1703030400000",
"number": "1790554632",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11301 WILSHIRE BLVD",
"address_2": "BLDG 401, RM B131",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90073",
"telephone_number": "310-478-3711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11301 WILSHIRE BLVD",
"address_2": "BLDG 401, RM B131",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90073",
"telephone_number": "310-478-3711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CONNELLY",
"first_name": "DYAN",
"middle_name": "ELIZABETH",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-12-20",
"last_updated": "2023-12-20",
"certification_date": "2023-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY34498",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.