MEDICARE: GINA CONNOR LICSW

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	121637	MA

General Provider Information

NPI Number	:	1689130825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA CONNOR LICSW

Provider Business Mailing Address
First Line	:	41A PARK AVE # 2
Second Line	:
City	:	HULL
State	:	MA
Zip	:	02045-4108
Country	:	US
Telephone Number	:	781-974-4802
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 OLD DERBY ST STE 202
Second Line	:
City	:	HINGHAM
State	:	MA
Zip	:	02043-4066
Country	:	US
Telephone Number	:	781-974-4802
Fax Number	:

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

Provider Enumeration Date	:	02/12/2019
Last Update Date	:	01/12/2022

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Directions to “ GINA CONNOR LICSW” Practice Location

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