Teresa Josephine Connelly, MA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP2332 Issued in MN

Practice address

1874 3Rd St SW
New Brighton, MN 55112

Phone

(763) 717-4979

Fax

(763) 717-4954

NPI assigned

Nov 12, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 8

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1163289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659312000000",
    "number": "1992876064",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "277 COON RAPIDS BLVD NW",
            "address_2": "SUITE 308",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554335843",
            "telephone_number": "763-717-4979",
            "fax_number": "763-717-4954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1874 3RD ST SW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "55112",
            "telephone_number": "763-717-4979",
            "fax_number": "763-717-4954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNELLY",
        "first_name": "TERESA",
        "middle_name": "JOSEPHINE",
        "name_prefix": "Ms.",
        "credential": "MA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-12",
        "last_updated": "2022-08-01",
        "certification_date": "2022-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "MN",
            "license": "LP2332",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "MN",
            "license": "LP2332",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "MN",
            "license": "LP2332",
            "primary": false
        },
        {
            "code": "103TP2701X",
            "taxonomy_group": "",
            "desc": "Psychologist, Group Psychotherapy",
            "state": "MN",
            "license": "LP2332",
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "MN",
            "license": "LP2332",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP2332",
            "primary": true
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MN",
            "license": "LP2332",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP2332",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUECROSS PROVIDER NUMBER",
            "identifier": "57348CO",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Clinical Psychologist in New Brighton, MN
• Providers in New Brighton, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2022; 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.