Provider Demographics
NPI:1366597106
Name:CONNER-RAINES, JUANITA SABRINA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JUANITA
Middle Name:SABRINA
Last Name:CONNER-RAINES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 246464
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-0124
Mailing Address - Country:US
Mailing Address - Phone:954-322-0538
Mailing Address - Fax:954-322-9897
Practice Address - Street 1:269 N UNIVERSITY DR
Practice Address - Street 2:SUITE G
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6715
Practice Address - Country:US
Practice Address - Phone:954-322-0538
Practice Address - Fax:954-322-9897
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 44101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6940AMedicare ID - Type UnspecifiedINDIVIDUAL PRACTICIONER