Provider Demographics
NPI:1831265818
Name:PRATT, MARY CONNARE (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CONNARE
Last Name:PRATT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25541 PACIFIC HILLS DR
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-5047
Mailing Address - Country:US
Mailing Address - Phone:949-584-5572
Mailing Address - Fax:
Practice Address - Street 1:23161 LAKE CENTER DR
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-6803
Practice Address - Country:US
Practice Address - Phone:949-273-8833
Practice Address - Fax:949-273-8834
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical