Provider Demographics
NPI:1639421605
Name:CONNELLY MARCEAU, ERIN COLLEEN (LMSW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:COLLEEN
Last Name:CONNELLY MARCEAU
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 1:437 N TOPEKA ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-2413
Mailing Address - Country:US
Mailing Address - Phone:316-264-8344
Mailing Address - Fax:
Practice Address - Street 1:437 N TOPEKA ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-2413
Practice Address - Country:US
Practice Address - Phone:316-264-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-15
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS8576104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker