Provider Demographics
NPI:1457410706
Name:CONWAY, PATRICIA M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:M
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 1:35 PINE RIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:WAYLAND
Mailing Address - State:MA
Mailing Address - Zip Code:01778
Mailing Address - Country:US
Mailing Address - Phone:508-655-4514
Mailing Address - Fax:
Practice Address - Street 1:8 GROVE STREET
Practice Address - Street 2:SUITE 303
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7777
Practice Address - Country:US
Practice Address - Phone:781-431-7323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7120103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7172338OtherAETNA
MA416218OtherMAGELLAN
MA11406342OtherCAQH PROVIDER ID
MAWO5559OtherBLUE CROSS BLUE SHIELD
MAW50940OtherMEDICARE