Provider Demographics
NPI:1710126545
Name:MCCONNER, HERMORNE THERESA (08/30/08)
Entity Type:Individual
Prefix:MISS
First Name:HERMORNE
Middle Name:THERESA
Last Name:MCCONNER
Suffix:
Gender:F
Credentials:08/30/08
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CHURCH ST
Mailing Address - Street 2:# 301
Mailing Address - City:WHITINSVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:01588-1464
Mailing Address - Country:US
Mailing Address - Phone:508-234-4181
Mailing Address - Fax:508-234-3944
Practice Address - Street 1:76 CHURCH ST
Practice Address - Street 2:# 301
Practice Address - City:WHITINSVILLE
Practice Address - State:MA
Practice Address - Zip Code:01588-1464
Practice Address - Country:US
Practice Address - Phone:508-234-4181
Practice Address - Fax:508-234-3944
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health