Provider Demographics
NPI:1376643205
Name:CONWAY, KATHLEEN D (APRN, BC, CS)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:D
Last Name:CONWAY
Suffix:
Gender:F
Credentials:APRN, BC, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WOODBINE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06853-1032
Mailing Address - Country:US
Mailing Address - Phone:203-855-1185
Mailing Address - Fax:203-854-5121
Practice Address - Street 1:20 WOODBINE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06853-1032
Practice Address - Country:US
Practice Address - Phone:203-855-1185
Practice Address - Fax:203-854-5121
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTAPRN 002714101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health