Provider Demographics
NPI:1780205336
Name:KONRADY, MAREN RACHEL
Entity Type:Individual
Prefix:
First Name:MAREN
Middle Name:RACHEL
Last Name:KONRADY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MASLIN VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:VA
Mailing Address - Zip Code:22645-1940
Mailing Address - Country:US
Mailing Address - Phone:540-532-5627
Mailing Address - Fax:
Practice Address - Street 1:200 MASLIN VALLEY LN
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:VA
Practice Address - Zip Code:22645-1940
Practice Address - Country:US
Practice Address - Phone:540-532-5627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-05
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician