Provider Demographics
NPI:1083630172
Name:CONWELL, AMY L (LICSW)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:CONWELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 POSSUM HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-2514
Mailing Address - Country:US
Mailing Address - Phone:508-651-7977
Mailing Address - Fax:
Practice Address - Street 1:705 MOUNT AUBURN ST
Practice Address - Street 2:MENTAL HEALTH DEPARTMENT
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-1508
Practice Address - Country:US
Practice Address - Phone:888-766-9818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
10245201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical