Provider Demographics
NPI:1184358095
Name:CONLEY, KIMBERLY MARIE (LCSW)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MARIE
Last Name:CONLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:MARIE
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 N JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101-2238
Mailing Address - Country:US
Mailing Address - Phone:724-654-9555
Mailing Address - Fax:724-498-0976
Practice Address - Street 1:2500 HIGHLAND RD STE 102
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4602
Practice Address - Country:US
Practice Address - Phone:724-654-9555
Practice Address - Fax:724-498-0976
Is Sole Proprietor?:No
Enumeration Date:2022-07-15
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW025314104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA28036117OtherDRIVERS LICENSE
PASW135427OtherCLINICAL LICENSE