Provider Information for 1609939842
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Ms. MARTHA JO MCCONNELL L.C.S.W.
Sex: Female
NPI: 1609939842
Last Updated: 2013-05-20
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1609939842 | ||||||||
| Enumeration Date | 2006-12-19 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 1163 ROUTE 14 SOUTH LYONS, NY 14489 United States Phone: 315-539-4049 | Fax:315-539-4394 | ||||||||
| Primary Practice Address | 1083 WATERLOO GENEVA RD WATERLOO, NY 13165-1202 United States Phone: 315-539-4049 | Fax:315-539-4394 | ||||||||
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