1558429852 NPI number — MRS. CHRISTINE M CONWAY-O'DONNELL LCSW, LCADC

Table of content: MRS. CHRISTINE M CONWAY-O'DONNELL LCSW, LCADC (NPI 1558429852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558429852 NPI number — MRS. CHRISTINE M CONWAY-O'DONNELL LCSW, LCADC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONWAY-O'DONNELL
Provider First Name:
CHRISTINE
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW, LCADC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558429852
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
268 BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BANK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07701-2003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-740-6881
Provider Business Mailing Address Fax Number:
732-571-3388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
268 BROAD ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
RED BANK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07701-2003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-740-6881
Provider Business Practice Location Address Fax Number:
732-571-3388
Provider Enumeration Date:
12/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)





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