Provider Demographics
NPI:1427599109
Name:PROANO, CONNIE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:PROANO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CONSUELO
Other - Middle Name:
Other - Last Name:PROANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:25 FLATBUSH AVE FL 3
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11217-1101
Mailing Address - Country:US
Mailing Address - Phone:718-875-1420
Mailing Address - Fax:718-875-5496
Practice Address - Street 1:25 FLATBUSH AVE FL 3
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11217-1101
Practice Address - Country:US
Practice Address - Phone:718-875-1420
Practice Address - Fax:718-875-5496
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021959103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical