Provider Demographics
NPI:1003054362
Name:MCCONNICO, NEENA NICOLE (MA, LMHC)
Entity Type:Individual
Prefix:MRS
First Name:NEENA
Middle Name:NICOLE
Last Name:MCCONNICO
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02302-2336
Mailing Address - Country:US
Mailing Address - Phone:508-580-8546
Mailing Address - Fax:
Practice Address - Street 1:95 RIVER ST
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02302-2336
Practice Address - Country:US
Practice Address - Phone:508-580-8546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-25
Last Update Date:2009-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6427101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health