Provider Demographics
NPI:1790284560
Name:CONWAY, ANTONIO DANTE (CDCA)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:DANTE
Last Name:CONWAY
Suffix:
Gender:M
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8351 STATE ROUTE 46
Mailing Address - Street 2:
Mailing Address - City:ORWELL
Mailing Address - State:OH
Mailing Address - Zip Code:44076-9389
Mailing Address - Country:US
Mailing Address - Phone:440-321-9063
Mailing Address - Fax:
Practice Address - Street 1:3622 PROSPECT AVE E
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-2704
Practice Address - Country:US
Practice Address - Phone:216-431-4600
Practice Address - Fax:216-431-4601
Is Sole Proprietor?:No
Enumeration Date:2018-02-07
Last Update Date:2018-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH011383101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)