Provider Demographics
NPI:1518237247
Name:CONIGLIARO, KEISHA AMANDA (CPT)
Entity Type:Individual
Prefix:MRS
First Name:KEISHA
Middle Name:AMANDA
Last Name:CONIGLIARO
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 CABOT ST
Mailing Address - Street 2:UNIT 2
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-2594
Mailing Address - Country:US
Mailing Address - Phone:978-596-6839
Mailing Address - Fax:
Practice Address - Street 1:131 RANTOUL ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-4240
Practice Address - Country:US
Practice Address - Phone:978-921-1190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
MACON66101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor