Provider Demographics
NPI:1154431328
Name:MCCONNELL, KAREN SUE (LCSW)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:SUE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1 LINCOLN ST
Mailing Address - Street 2:SUITE #3
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530
Mailing Address - Country:US
Mailing Address - Phone:207-443-6233
Mailing Address - Fax:207-443-6233
Practice Address - Street 1:1 LINCOLN ST
Practice Address - Street 2:SUITE #3
Practice Address - City:BATH
Practice Address - State:ME
Practice Address - Zip Code:04530
Practice Address - Country:US
Practice Address - Phone:207-443-6233
Practice Address - Fax:207-443-6233
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC52271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
038989OtherBCBS
7740280OtherAETNA
MCMM8405Medicare ID - Type Unspecified
7740280OtherAETNA