Provider Demographics
NPI:1033324397
Name:CONLEY, RENA (PHD)
Entity type:Individual
Prefix:DR
First Name:RENA
Middle Name:
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 NE 26TH STREET,
Mailing Address - Street 2:SUITE 216
Mailing Address - City:WILTON MANORS
Mailing Address - State:FL
Mailing Address - Zip Code:33305-1400
Mailing Address - Country:US
Mailing Address - Phone:954-727-9712
Mailing Address - Fax:954-566-7671
Practice Address - Street 1:1881 NE 26TH STREET,
Practice Address - Street 2:SUITE 216
Practice Address - City:WILTON MANORS
Practice Address - State:FL
Practice Address - Zip Code:33305-1400
Practice Address - Country:US
Practice Address - Phone:954-727-9712
Practice Address - Fax:954-566-7671
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
73608Medicare ID - Type Unspecified