Provider Demographics
NPI:1952737785
Name:CONERLY, CAROLYN ELAINE (MSW)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELAINE
Last Name:CONERLY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1185 W MOUNTAIN VIEW RD
Mailing Address - Street 2:2209
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2523
Mailing Address - Country:US
Mailing Address - Phone:423-863-5328
Mailing Address - Fax:
Practice Address - Street 1:1185 W MOUNTAIN VIEW RD
Practice Address - Street 2:2209
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2523
Practice Address - Country:US
Practice Address - Phone:423-863-5328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical