Provider Demographics
NPI:1821300369
Name:MAY, CONNIE D (MA)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:D
Last Name:MAY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2140 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-3734
Mailing Address - Country:US
Mailing Address - Phone:916-787-8717
Mailing Address - Fax:916-787-5616
Practice Address - Street 1:2140 PROFESSIONAL DR
Practice Address - Street 2:SUITE 205
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-3734
Practice Address - Country:US
Practice Address - Phone:916-787-8717
Practice Address - Fax:916-787-5616
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2013-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48343106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist