Provider Demographics
NPI:1104940246
Name:LIDEN, CONNIE MAYE (MA MFCC)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:MAYE
Last Name:LIDEN
Suffix:
Gender:F
Credentials:MA MFCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 SARATOGA AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129
Mailing Address - Country:US
Mailing Address - Phone:408-249-8047
Mailing Address - Fax:408-249-9240
Practice Address - Street 1:920 SARATOGA AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129
Practice Address - Country:US
Practice Address - Phone:408-249-8047
Practice Address - Fax:408-249-9240
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25008106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist