Provider Demographics
NPI:1407479991
Name:CONWAY, ROBIN (MSSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROBIN
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MSSW, LCSW
Other - Prefix:MISS
Other - First Name:ROBIN
Other - Middle Name:MARIE
Other - Last Name:FAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW, CSW, MSSW, LCSW
Mailing Address - Street 1:10205 GARLANREID PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2969
Mailing Address - Country:US
Mailing Address - Phone:502-417-4708
Mailing Address - Fax:
Practice Address - Street 1:10205 GARLANREID PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2969
Practice Address - Country:US
Practice Address - Phone:502-417-4708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-19
Last Update Date:2020-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1323104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker