Provider Demographics
NPI:1629370812
Name:CASSANDRA MCCONN INC
Entity Type:Organization
Organization Name:CASSANDRA MCCONN INC
Other - Org Name:MCCONN PARTNERSHIPS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CASSANDRA
Authorized Official - Middle Name:JANE
Authorized Official - Last Name:MCCONN
Authorized Official - Suffix:
Authorized Official - Credentials:DCSW, QCSW, ACSW
Authorized Official - Phone:812-331-7399
Mailing Address - Street 1:3716 E CAMERON AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-4212
Mailing Address - Country:US
Mailing Address - Phone:812-331-7399
Mailing Address - Fax:812-334-3438
Practice Address - Street 1:3716 E CAMERON AVE
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-4212
Practice Address - Country:US
Practice Address - Phone:812-331-7399
Practice Address - Fax:812-334-3438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-22
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty