Healthcare Provider Details

I. General information

NPI: 1932013380
Provider Name (Legal Business Name): MARYANNE CONNOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1679 BLOOMFIELD PLACE DR APT 529B
BLOOMFIELD TOWNSHIP MI
48302-0887
US

IV. Provider business mailing address

1679 BLOOMFIELD PLACE DR APT 529B
BLOOMFIELD TOWNSHIP MI
48302-0887
US

V. Phone/Fax

Practice location:
  • Phone: 415-416-4127
  • Fax:
Mailing address:
  • Phone: 415-416-4127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6851109469
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: