Provider Demographics
NPI:1023172640
Name:CURTISS, CONNIE (LCSW MSW)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:
Last Name:CURTISS
Suffix:
Gender:F
Credentials:LCSW MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7910 LAKEVIEW STREET
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641
Mailing Address - Country:US
Mailing Address - Phone:512-258-7646
Mailing Address - Fax:512-249-9412
Practice Address - Street 1:7910 LAKEVIEW STREET
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641
Practice Address - Country:US
Practice Address - Phone:512-258-7646
Practice Address - Fax:512-249-9412
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16553104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
UR60089Medicare UPIN
TX00522VMedicare ID - Type Unspecified