Provider Demographics
NPI:1518189364
Name:CONLEY, DOUGLAS (LISW)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:
Last Name:CONLEY
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2415 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2701
Mailing Address - Country:US
Mailing Address - Phone:513-221-4949
Mailing Address - Fax:513-241-4191
Practice Address - Street 1:2805 GILBERT AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45206-1210
Practice Address - Country:US
Practice Address - Phone:513-281-4116
Practice Address - Fax:513-281-1492
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00015271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO2034922Medicare PIN
CO2034921Medicare PIN
CO2034923Medicare PIN