Provider Demographics
NPI:1891010468
Name:CONOVER, RICHARD J (LCSW)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:CONOVER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 TOWN ST
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2315
Mailing Address - Country:US
Mailing Address - Phone:860-892-7042
Mailing Address - Fax:860-892-7043
Practice Address - Street 1:47 TOWN ST
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2315
Practice Address - Country:US
Practice Address - Phone:860-892-7042
Practice Address - Fax:860-892-7043
Is Sole Proprietor?:No
Enumeration Date:2010-04-07
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0025671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004235942Medicaid
CT004235942Medicaid