Provider Demographics
NPI:1124195722
Name:CONWAY, MAUREEN (PMHNP)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 COLLEGE PKWY STE 255
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-6886
Mailing Address - Country:US
Mailing Address - Phone:716-573-1991
Mailing Address - Fax:
Practice Address - Street 1:100 COLLEGE PKWY STE 255
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-6886
Practice Address - Country:US
Practice Address - Phone:716-573-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200350118NP363LP0808X
NY4040042084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR858593000OtherBLUE CROSS BLUE SHIELD