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General NPI Number Information
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NPI Number | 1053127126
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Entity Type | Individual
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Provider Name | CONNOR ROBERT HENRY LICSW
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Gender | Male
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Dates
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Enumeration Date | 12/04/2024
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Last Update Date | 12/04/2024
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Provider Practice Location Address
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Address Line | 175 DERBT STREET SUITE 21
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City | HINGHAM
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State | MA
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Zip | 02043
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Country | US
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Telephone | 781-424-8119
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Fax |
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Provider Business Mailing Address
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Address Line | 1258 MASSACHUSETTS AVE APT 508
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City | BOSTON
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State | MA
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Zip | 02125-4803
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Country | US
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Telephone | 860-818-1029
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW1120143
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License Number State | MA
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