Provider Demographics
NPI:1609238013
Name:CONWAY, MELISSA (PHD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 W END AVE
Mailing Address - Street 2:APT. 26L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-5601
Mailing Address - Country:US
Mailing Address - Phone:201-401-5850
Mailing Address - Fax:
Practice Address - Street 1:66 W MOUNT PLEASANT AVE STE 206
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-2900
Practice Address - Country:US
Practice Address - Phone:646-656-0747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-24
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical