Provider Demographics
NPI:1245641547
Name:CONWAY, ABRIELLE D (PSYD)
Entity type:Individual
Prefix:DR
First Name:ABRIELLE
Middle Name:D
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 SE 21ST PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-1437
Mailing Address - Country:US
Mailing Address - Phone:239-439-8900
Mailing Address - Fax:888-975-1981
Practice Address - Street 1:112 ROBERTS RD UNIT 4
Practice Address - Street 2:
Practice Address - City:CAMPBELLSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42718-1593
Practice Address - Country:US
Practice Address - Phone:238-439-8900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-08
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004987103TC0700X
KY1779103TC0700X
KY130473103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical