Provider Demographics
NPI:1003363995
Name:CONLEY, AMANDA (MA)
Entity Type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 621
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44501-0621
Mailing Address - Country:US
Mailing Address - Phone:216-299-7736
Mailing Address - Fax:
Practice Address - Street 1:20600 CHAGRIN BLVD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-5327
Practice Address - Country:US
Practice Address - Phone:216-299-7736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2847496Medicaid