Provider Demographics
NPI:1982880621
Name:CONNOR, SIMON S (MSW, LICSW)
Entity Type:Individual
Prefix:MR
First Name:SIMON
Middle Name:S
Last Name:CONNOR
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 24TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-3626
Mailing Address - Country:US
Mailing Address - Phone:206-550-6492
Mailing Address - Fax:
Practice Address - Street 1:2800 E MADISON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4871
Practice Address - Country:US
Practice Address - Phone:206-550-6492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000087051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical