Provider Demographics
NPI:1770048183
Name:NATASHA MEDEIROS CONLEY, PSY.D., LLC
Entity type:Organization
Organization Name:NATASHA MEDEIROS CONLEY, PSY.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NATASHA
Authorized Official - Middle Name:MEDEIROS
Authorized Official - Last Name:CONLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:774-263-1284
Mailing Address - Street 1:206 PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:MILLIS
Mailing Address - State:MA
Mailing Address - Zip Code:02054-1720
Mailing Address - Country:US
Mailing Address - Phone:774-263-1284
Mailing Address - Fax:508-422-0261
Practice Address - Street 1:288 WEST ST STE 3B
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:MA
Practice Address - Zip Code:01757-1234
Practice Address - Country:US
Practice Address - Phone:508-794-5093
Practice Address - Fax:508-422-0261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-11
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1659636975OtherNPI