Provider Demographics
NPI:1851517015
Name:CONATY, ANNA JANETTE (LISW, ATR)
Entity Type:Individual
Prefix:MS
First Name:ANNA
Middle Name:JANETTE
Last Name:CONATY
Suffix:
Gender:F
Credentials:LISW, ATR
Other - Prefix:MS
Other - First Name:ANNA
Other - Middle Name:JANETTE
Other - Last Name:CONATY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW, ATR
Mailing Address - Street 1:4464 S DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5464
Mailing Address - Country:US
Mailing Address - Phone:513-649-8008
Mailing Address - Fax:513-649-8004
Practice Address - Street 1:4464 S DIXIE HWY
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5464
Practice Address - Country:US
Practice Address - Phone:513-649-8008
Practice Address - Fax:513-649-8004
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.14510681041C0700X, 101YM0800X
TX#07-031221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0074946OtherMEDICAID LEGACY NUMBER MENTAL HEALTH
OH0074861OtherMEDICAID LEGACY NUMBER CHEMICAL DEPENDENCY
OHH130910OtherGROUP MEDICARE PTAN