Provider Demographics
NPI:1447200035
Name:CAMBRON-ADAMS, CONNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:CAMBRON-ADAMS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:GWEN
Other - Last Name:ROMANE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2000 W PIONEER PKWY STE 3
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1883
Mailing Address - Country:US
Mailing Address - Phone:309-210-3055
Mailing Address - Fax:
Practice Address - Street 1:2000 W PIONEER PKWY STE 3
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1883
Practice Address - Country:US
Practice Address - Phone:309-210-3055
Practice Address - Fax:309-686-1185
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490085481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
K20747Medicare ID - Type Unspecified