Provider Demographics
NPI:1649582180
Name:CONWAY, RACHEL (PSYD)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 CAMINO DEL RIO S STE 205
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3719
Mailing Address - Country:US
Mailing Address - Phone:858-386-0993
Mailing Address - Fax:858-408-7416
Practice Address - Street 1:2525 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 205
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3717
Practice Address - Country:US
Practice Address - Phone:858-386-0993
Practice Address - Fax:858-408-7416
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-13
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25309103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR890AOtherMEDICARE PTAN