Individual provider Active NPI

Craig F. Conner, LCSW

  • Clinical Social Worker
  • Covina, CA
National Provider Identifier
1831234640
Registry record updated Jul 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
LCS 29577 Issued in CA
Practice address
1126 N Grand Ave
Covina, CA 91724-1551
Phone
(626) 967-1667
NPI assigned
Feb 20, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 3, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X ASW 9358 CA
Clinical Social Worker 1041C0700X LCS 29577 CA Primary

Addresses

Primary practice location

1126 N Grand Ave
Covina, CA 91724-1551

Mailing address

850 E Comstock Ave
Glendora, CA 91741-2826
Phone (626) 963-1565

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20131107001641 CA Practitioner - Clinical Social Worker 5395970891 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Masonic Homes of CaliforniaGroup PAC ID 4183625361, 7 clinicians

Practice addresses (Care Compare)

1650 E Old Badillo St
Covina, CA 91724-3163
Phone (626) 251-2200

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
ASW 9358CAMDMental Health Counselor
LCS 29577CAMDClinical Social Worker
29577CAMDSports Physical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Masonic Homes of California CurrentSince Nov 1, 2020 Accepting new patients
Masonic Homes of California Current Accepting new patients
Masonic Homes of California CurrentSince Nov 1, 2020 Accepting new patients
Masonic Homes of California Past Accepting new patients

Locations

1650 E Old Badillo St
Ste B3
Covina, CA 91724

1650 E Old Badillo St
Covina, CA 91724
Phone (626) 251-2200

1111 California St
San Francisco, CA 94108

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171929600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1372809600000",
    "number": "1831234640",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "850 E COMSTOCK AVE",
            "city": "GLENDORA",
            "state": "CA",
            "postal_code": "917412826",
            "telephone_number": "626-963-1565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1126 N GRAND AVE",
            "city": "COVINA",
            "state": "CA",
            "postal_code": "917241551",
            "telephone_number": "626-967-1667"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CONNER",
        "first_name": "CRAIG",
        "middle_name": "F.",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-20",
        "last_updated": "2013-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "ASW 9358",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 29577",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Covina, CA

Sources for this page

Verify at the official NPI Registry.