MEDICARE: SEAN CONCANNON LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904019773	VA

General Provider Information

NPI Number	:	1609733674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SEAN CONCANNON LCSW

Provider Business Mailing Address
First Line	:	4112 E PARHAM RD STE A
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-2753
Country	:	US
Telephone Number	:	804-562-6527
Fax Number	:

Provider Business Practice Location Address
First Line	:	4112 E PARHAM RD STE A
Second Line	:
City	:	HENRICO
State	:	VA
Zip	:	23228-2753
Country	:	US
Telephone Number	:	804-562-6527
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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