Provider Demographics
NPI:1275708422
Name:MARTINDALE, CONWAY CLARENCE (CASAC)
Entity Type:Individual
Prefix:
First Name:CONWAY
Middle Name:CLARENCE
Last Name:MARTINDALE
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 JOHN STREET
Mailing Address - Street 2:27 FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:212-385-0086
Mailing Address - Fax:212-732-0757
Practice Address - Street 1:116 JOHN STREET
Practice Address - Street 2:27 FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038
Practice Address - Country:US
Practice Address - Phone:212-385-0086
Practice Address - Fax:212-732-0757
Is Sole Proprietor?:No
Enumeration Date:2008-04-29
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY20317101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)