Provider Demographics
NPI:1659636975
Name:CONLEY, NATASHA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:M
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:
Other - Last Name:MEDEIROS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:859 WILLARD ST
Mailing Address - Street 2:SUITE 430
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7482
Mailing Address - Country:US
Mailing Address - Phone:617-689-1818
Mailing Address - Fax:617-471-9859
Practice Address - Street 1:859 WILLARD ST
Practice Address - Street 2:SUITE 430
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169
Practice Address - Country:US
Practice Address - Phone:617-689-1818
Practice Address - Fax:617-471-9859
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program