Provider Demographics
NPI:1457369076
Name:DEEN, CONNIE E (LCSW)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:E
Last Name:DEEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CONSTANCE
Other - Middle Name:S
Other - Last Name:ESTES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:955 AUTUMN PT
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62901-5259
Mailing Address - Country:US
Mailing Address - Phone:618-910-4979
Mailing Address - Fax:
Practice Address - Street 1:1006 S DIVISION ST
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1539
Practice Address - Country:US
Practice Address - Phone:618-985-4841
Practice Address - Fax:618-985-8101
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK14971Medicare PIN
ILQ00741Medicare UPIN