Provider Demographics
NPI:1952579005
Name:CONWAY, BARBARA
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31600 TELEGRAPH RD STE 280
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4317
Mailing Address - Country:US
Mailing Address - Phone:248-646-7935
Mailing Address - Fax:248-647-3574
Practice Address - Street 1:31600 TELEGRAPH RD STE 280
Practice Address - Street 2:
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4317
Practice Address - Country:US
Practice Address - Phone:248-646-7935
Practice Address - Fax:248-647-3574
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI006042103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI620F34825OtherBCBS PIN #