Provider Demographics
NPI:1649774217
Name:CONNOR, CHARMIN HOWARD (MSW)
Entity Type:Individual
Prefix:
First Name:CHARMIN
Middle Name:HOWARD
Last Name:CONNOR
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2066 SW PROVIDENCE PL
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-4385
Mailing Address - Country:US
Mailing Address - Phone:772-501-5572
Mailing Address - Fax:
Practice Address - Street 1:2066 SW PROVIDENCE PL
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-4385
Practice Address - Country:US
Practice Address - Phone:772-501-5572
Practice Address - Fax:772-501-5572
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-20
Last Update Date:2018-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty