Provider Demographics
NPI:1689811713
Name:CONNOR, MARVA DIANE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARVA
Middle Name:DIANE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7025 FLIGHT AVE.
Mailing Address - Street 2:#4
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045
Mailing Address - Country:US
Mailing Address - Phone:909-437-7822
Mailing Address - Fax:
Practice Address - Street 1:2500 W MANCHESTER BLVD
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:AZ
Practice Address - Zip Code:90305
Practice Address - Country:US
Practice Address - Phone:323-750-5885
Practice Address - Fax:323-750-5885
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS86101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical