Provider Demographics
NPI:1972763365
Name:HOBSON, CONNIE DEAN
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:DEAN
Last Name:HOBSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:195 E SAN FERNANDO ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-3503
Mailing Address - Country:US
Mailing Address - Phone:408-899-7145
Mailing Address - Fax:408-280-1026
Practice Address - Street 1:195 E. SAN FERNANDO STREET
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-3503
Practice Address - Country:US
Practice Address - Phone:408-899-7145
Practice Address - Fax:408-280-1026
Is Sole Proprietor?:No
Enumeration Date:2008-06-10
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41320Medicaid
CA41320Medicaid