Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | SW 12201 | FL |
NPI | 1003217233 |
---|---|
Provider Name | Lidia Emperatriz Conners |
First Address | Veraguas, PANAMA 507 |
Second Address | Leavenworth, KS 66048-2642 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2014 |
Last Update Date | 17/03/2018 |