Provider Demographics
NPI:1407083439
Name:CONWAY, CHRISTOPHER CALLAHAN (PHD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:CALLAHAN
Last Name:CONWAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 N HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1339
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:421 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1339
Practice Address - Country:US
Practice Address - Phone:845-353-3399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-17
Last Update Date:2022-03-16
Deactivation Date:2022-01-11
Deactivation Code:
Reactivation Date:2022-02-23
Provider Licenses
StateLicense IDTaxonomies
NY024132103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical