Provider Demographics
NPI:1619358835
Name:CONNOR, PATIENCE (MST)
Entity Type:Individual
Prefix:
First Name:PATIENCE
Middle Name:
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2630 CROPSEY AVE
Mailing Address - Street 2:15C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11214-6757
Mailing Address - Country:US
Mailing Address - Phone:516-780-5526
Mailing Address - Fax:
Practice Address - Street 1:2630 CROPSEY AVE
Practice Address - Street 2:15C
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11214-6757
Practice Address - Country:US
Practice Address - Phone:516-780-5526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-12
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst