Provider Demographics
NPI:1902937766
Name:CONRAD, CONNIE CAGLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CONNIE
Middle Name:CAGLE
Last Name:CONRAD
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 1:148 SANTA RITA RD
Mailing Address - Street 2:
Mailing Address - City:DALE
Mailing Address - State:TX
Mailing Address - Zip Code:78616-2986
Mailing Address - Country:US
Mailing Address - Phone:512-601-3113
Mailing Address - Fax:512-601-3113
Practice Address - Street 1:148 SANTA RITA RD
Practice Address - Street 2:
Practice Address - City:DALE
Practice Address - State:TX
Practice Address - Zip Code:78616-2986
Practice Address - Country:US
Practice Address - Phone:512-601-3113
Practice Address - Fax:512-601-3113
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical