Provider Demographics
NPI:1205519410
Name:MCCONNAUGHEY, ADAM CORON (LICSW)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:CORON
Last Name:MCCONNAUGHEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 33RD AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-2236
Mailing Address - Country:US
Mailing Address - Phone:651-968-1467
Mailing Address - Fax:
Practice Address - Street 1:920 33RD AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-2236
Practice Address - Country:US
Practice Address - Phone:651-968-1467
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN248941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical