Provider Demographics
NPI:1396952859
Name:CONCANNON, CONNIE ANNE (MSW)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:ANNE
Last Name:CONCANNON
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 1:1844 SAN MIGUEL DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4962
Mailing Address - Country:US
Mailing Address - Phone:925-944-1800
Mailing Address - Fax:925-944-0684
Practice Address - Street 1:1844 SAN MIGUEL DR
Practice Address - Street 2:SUITE 311
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4962
Practice Address - Country:US
Practice Address - Phone:925-944-1800
Practice Address - Fax:925-944-0684
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS68571041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist