Healthcare Provider Details

I. General information

NPI: 1619659398
Provider Name (Legal Business Name): DANA COLLEEN CONNOR LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2023
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 WEST ST
PITTSFIELD MA
01201-5716
US

IV. Provider business mailing address

1012 WEST ST
PITTSFIELD MA
01201-5716
US

V. Phone/Fax

Practice location:
  • Phone: 413-446-6523
  • Fax:
Mailing address:
  • Phone: 413-446-6523
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLCSW2144062
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW.09933654
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW1145156
License Number StateMA
# 4
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW.0009924563
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: