Provider Demographics
NPI:1255431011
Name:CONDON, ANN BLUNT (MSW)
Entity type:Individual
Prefix:MS
First Name:ANN
Middle Name:BLUNT
Last Name:CONDON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WOODVALE LN
Mailing Address - Street 2:PO BOX 58
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-2220
Mailing Address - Country:US
Mailing Address - Phone:508-775-2059
Mailing Address - Fax:508-775-8780
Practice Address - Street 1:7 WOODVALE LN
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02632-2220
Practice Address - Country:US
Practice Address - Phone:508-775-2059
Practice Address - Fax:508-775-8780
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1048521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAMA 104852OtherLICSW LICENSE
P03008OtherBXBS