Provider Demographics
NPI:1922471606
Name:CONLEY, CATHERINE ITALIA (LCSW-C)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ITALIA
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8718 PINE SAP LN
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-4903
Mailing Address - Country:US
Mailing Address - Phone:301-461-1341
Mailing Address - Fax:
Practice Address - Street 1:12301 ACADEMY WAY
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2000
Practice Address - Country:US
Practice Address - Phone:443-923-4183
Practice Address - Fax:443-923-4181
Is Sole Proprietor?:No
Enumeration Date:2015-11-04
Last Update Date:2015-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD137131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15512Medicaid