Provider Demographics
NPI:1467997197
Name:MCCONVILLE, ANN
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:MCCONVILLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3293 CAHUENGA BLVD W
Mailing Address - Street 2:103
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-1337
Mailing Address - Country:US
Mailing Address - Phone:818-280-7475
Mailing Address - Fax:
Practice Address - Street 1:3293 CAHUENGA BLVD W
Practice Address - Street 2:103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90068-1337
Practice Address - Country:US
Practice Address - Phone:818-280-7475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-04
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker