Provider Demographics
NPI:1467191973
Name:CONOVER, MARA JUDYTH-ALICE (MSW)
Entity Type:Individual
Prefix:
First Name:MARA
Middle Name:JUDYTH-ALICE
Last Name:CONOVER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 N GOLDENROD RD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-8823
Mailing Address - Country:US
Mailing Address - Phone:407-712-7480
Mailing Address - Fax:
Practice Address - Street 1:323 E KENNEDY BLVD STE A
Practice Address - Street 2:
Practice Address - City:EATONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32751-5304
Practice Address - Country:US
Practice Address - Phone:407-629-5655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-02
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical