Provider Demographics
NPI:1437811387
Name:MCCABE, CONNOR (AMFT)
Entity Type:Individual
Prefix:
First Name:CONNOR
Middle Name:
Last Name:MCCABE
Suffix:
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 N LARCHMONT BLVD STE 506
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-6405
Mailing Address - Country:US
Mailing Address - Phone:310-853-3521
Mailing Address - Fax:
Practice Address - Street 1:321 N LARCHMONT BLVD STE 506
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-6405
Practice Address - Country:US
Practice Address - Phone:310-853-3521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-07
Last Update Date:2023-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139105106H00000X
CAAMFT123893106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist