Healthcare Provider Details

I. General information

NPI: 1245265396
Provider Name (Legal Business Name): CONNIE MARIE CRAMER MSW, LCSW, BCD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 10/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W LOSEY ST
SCOTT AFB IL
62225-5250
US

IV. Provider business mailing address

201 INDEPENDENCE 14TH MEDICAL GROUP
COLUMBUS MS
39710-5300
US

V. Phone/Fax

Practice location:
  • Phone: 618-229-5497
  • Fax: 618-256-7299
Mailing address:
  • Phone: 662-434-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2003017032
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: