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? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 104100000X | Behavioral Health & Social Service Providers | Social Worker | Group - Multi-Specialty |