Provider Demographics
NPI:1649993338
Name:CONCANNON, CHRISTI
Entity type:Individual
Prefix:MRS
First Name:CHRISTI
Middle Name:
Last Name:CONCANNON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 POND ST
Mailing Address - Street 2:
Mailing Address - City:NORWELL
Mailing Address - State:MA
Mailing Address - Zip Code:02061-1627
Mailing Address - Country:US
Mailing Address - Phone:781-421-6182
Mailing Address - Fax:
Practice Address - Street 1:218 WILLARD ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-1518
Practice Address - Country:US
Practice Address - Phone:781-421-6182
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst