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NPI Code Detail

MEDICARE: KATHRYN IRENE CONNOR LCSW

MEDICARE: KATHRYN IRENE CONNOR 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
11041C0700XClinical Social Worker0904018792VA

General Provider Information

NPI Number : 1720575061
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHRYN IRENE CONNOR LCSW
Provider Business Mailing Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : FORT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3551 ROGER BROOKE DR
Second Line :
City : FORT SAM HOUSTON
State : TX
Zip : 78234-4504
Country : US
Telephone Number : 210-916-7500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2018
Last Update Date : 12/11/2025

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