Provider Demographics
NPI:1518447044
Name:BURRY, CONNER (LMSW, MT-BC)
Entity Type:Individual
Prefix:
First Name:CONNER
Middle Name:
Last Name:BURRY
Suffix:
Gender:M
Credentials:LMSW, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1880 EAST RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14622-2473
Mailing Address - Country:US
Mailing Address - Phone:585-455-1544
Mailing Address - Fax:585-544-3884
Practice Address - Street 1:1800 EAST RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14622-2473
Practice Address - Country:US
Practice Address - Phone:585-455-1544
Practice Address - Fax:585-544-3884
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225A00000X
NY116545104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist