Provider Demographics
NPI:1205072915
Name:CONNOR, JESSICA ERIN (LCSW)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ERIN
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 1:4533 MACARTHUR BLVD STE 5025
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2059
Mailing Address - Country:US
Mailing Address - Phone:949-287-8297
Mailing Address - Fax:949-287-8297
Practice Address - Street 1:4533 MACARTHUR BLVD STE 5025
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2059
Practice Address - Country:US
Practice Address - Phone:949-287-8297
Practice Address - Fax:949-287-8297
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA221661041C0700X
CA277031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22166OtherACSW