Provider Demographics
NPI:1881102515
Name:CONWAY, MATTHEW S (PSYD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:S
Last Name:CONWAY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 CHESTNUT ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-3600
Mailing Address - Country:US
Mailing Address - Phone:978-749-2700
Mailing Address - Fax:
Practice Address - Street 1:26 CHESTNUT ST STE 2E
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3600
Practice Address - Country:US
Practice Address - Phone:978-749-2700
Practice Address - Fax:978-749-2700
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10747103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty