Provider Demographics
NPI:1629383146
Name:CONLAN, MAUREEN T (MA)
Entity Type:Individual
Prefix:MS
First Name:MAUREEN
Middle Name:T
Last Name:CONLAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 635
Mailing Address - Street 2:
Mailing Address - City:CALVERTON
Mailing Address - State:NY
Mailing Address - Zip Code:11933-0635
Mailing Address - Country:US
Mailing Address - Phone:631-369-4188
Mailing Address - Fax:
Practice Address - Street 1:184 WOODHULL AVE
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-3511
Practice Address - Country:US
Practice Address - Phone:631-369-4188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-09
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY6568260235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist