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General NPI Number Information
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NPI Number | 1043025695
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Entity Type | Individual
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Provider Name | CONNER JOHN MCKINZIE
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Gender | Male
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Dates
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Enumeration Date | 02/11/2025
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 107 W 82ND ST # LLP101
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City | NEW YORK
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State | NY
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Zip | 10024-5511
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Country | US
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Telephone | 646-389-4112
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Fax |
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Provider Business Mailing Address
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Address Line | 310 SAINT NICHOLAS AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-6566
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Country | US
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Telephone | 214-926-2284
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | P127394
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License Number State | NY
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