Provider Demographics
NPI:1750908604
Name:CONNER, CARSIN MARIE (LPC)
Entity type:Individual
Prefix:
First Name:CARSIN
Middle Name:MARIE
Last Name:CONNER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 WHITE ST
Mailing Address - Street 2:
Mailing Address - City:WEST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06516-5418
Mailing Address - Country:US
Mailing Address - Phone:732-977-7670
Mailing Address - Fax:
Practice Address - Street 1:85 STATE ST STE D
Practice Address - Street 2:
Practice Address - City:NORTH HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06473-2240
Practice Address - Country:US
Practice Address - Phone:732-977-7670
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-26
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT03-827119101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional