Provider Demographics
NPI:1922062447
Name:CONWAY, JOANNE B (EDD)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:B
Last Name:CONWAY
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 N EASTON RD
Mailing Address - Street 2:
Mailing Address - City:GLENSIDE
Mailing Address - State:PA
Mailing Address - Zip Code:19038-4903
Mailing Address - Country:US
Mailing Address - Phone:215-885-4489
Mailing Address - Fax:
Practice Address - Street 1:432 N EASTON RD
Practice Address - Street 2:
Practice Address - City:GLENSIDE
Practice Address - State:PA
Practice Address - Zip Code:19038-4903
Practice Address - Country:US
Practice Address - Phone:215-885-4489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-13
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005753L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
652414Medicare ID - Type Unspecified
BR652414Medicare UPIN