Provider Demographics
NPI:1912287863
Name:CONWAY, EILEEN M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:M
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:EILEEN
Other - Middle Name:
Other - Last Name:RIGDON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 1821
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85001-1821
Mailing Address - Country:US
Mailing Address - Phone:623-332-1828
Mailing Address - Fax:
Practice Address - Street 1:522 N CENTRAL AVE # 1821
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-2185
Practice Address - Country:US
Practice Address - Phone:623-252-1224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4363642103TS0200X
AZPSY-005391103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool