Provider Demographics
NPI:1497769889
Name:ATTERBERRY, CONNIE L (LMSW)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:L
Last Name:ATTERBERRY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S 1ST ST
Mailing Address - Street 2:CENTRAL TEXAS VETERANS HEALTH CARE SYSTEM
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76504-7451
Mailing Address - Country:US
Mailing Address - Phone:254-778-4811
Mailing Address - Fax:254-743-0495
Practice Address - Street 1:1901 S 1ST ST
Practice Address - Street 2:CENTRAL TEXAS VETERANS HEALTH CARE SYSTEM
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504-7451
Practice Address - Country:US
Practice Address - Phone:254-778-4811
Practice Address - Fax:254-743-0495
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03564104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker