Provider Demographics
NPI:1245374750
Name:CONLEY JUNG, CONNIE (PHD)
Entity type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:CONLEY JUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:RENATE
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1151 HARBOR BAY PARKWAY #137
Mailing Address - Street 2:
Mailing Address - City:ALEMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502
Mailing Address - Country:US
Mailing Address - Phone:510-769-1078
Mailing Address - Fax:
Practice Address - Street 1:1151 HARBOR BAY PARKWAY #137
Practice Address - Street 2:
Practice Address - City:ALEMEDA
Practice Address - State:CA
Practice Address - Zip Code:94502
Practice Address - Country:US
Practice Address - Phone:510-769-1078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19875103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical