Provider Demographics
NPI:1912386665
Name:ANGELA M CONWAY PA
Entity Type:Organization
Organization Name:ANGELA M CONWAY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOTHERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, CAP
Authorized Official - Phone:305-803-2884
Mailing Address - Street 1:2000 S DIXIE HWY STE 104
Mailing Address - Street 2:COCONUT GROVE COUNSELING CENTER
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33133-2441
Mailing Address - Country:US
Mailing Address - Phone:305-803-2884
Mailing Address - Fax:
Practice Address - Street 1:2000 S DIXIE HWY STE 104
Practice Address - Street 2:COCONUT GROVE COUNSELING CENTER
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-2441
Practice Address - Country:US
Practice Address - Phone:305-803-2884
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH-5106251B00000X
FLCAP 1801251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management