Provider Demographics
NPI:1427353432
Name:CONNERS, DANIEL P (LCSW)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:P
Last Name:CONNERS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4308 N KENMORE AVE
Mailing Address - Street 2:UNIT 2N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1327
Mailing Address - Country:US
Mailing Address - Phone:773-307-2541
Mailing Address - Fax:
Practice Address - Street 1:4308 N KENMORE AVE
Practice Address - Street 2:UNIT 2N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1327
Practice Address - Country:US
Practice Address - Phone:773-307-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0120051041C0700X
IL20937371041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool