Provider Demographics
NPI:1689130825
Name:CONNOR, GINA (LICSW)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:CONNOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41A PARK AVE # 2
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-4108
Mailing Address - Country:US
Mailing Address - Phone:781-974-4802
Mailing Address - Fax:
Practice Address - Street 1:190 OLD DERBY ST STE 202
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4066
Practice Address - Country:US
Practice Address - Phone:781-974-4802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1216371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical