Provider Demographics
NPI:1891965497
Name:CONNOR, TERESA MARIE (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:TERESA
Middle Name:MARIE
Last Name:CONNOR
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2375 UNIVERSITY AVE W
Mailing Address - Street 2:SUITE #160
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55114-1631
Mailing Address - Country:US
Mailing Address - Phone:651-642-1709
Mailing Address - Fax:
Practice Address - Street 1:2375 UNIVERSITY AVE W
Practice Address - Street 2:SUITE #160
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55114-1631
Practice Address - Country:US
Practice Address - Phone:651-642-1709
Practice Address - Fax:651-642-1709
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN20971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical