1962697714 NPI number — MRS. MADELINE WEISBERG CONWAY MSS LCSW

Table of content: MRS. MADELINE WEISBERG CONWAY MSS LCSW (NPI 1962697714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962697714 NPI number — MRS. MADELINE WEISBERG CONWAY MSS LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CONWAY
Provider First Name:
MADELINE
Provider Middle Name:
WEISBERG
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSS LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WEISBERG
Provider Other First Name:
MADGE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSS LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1962697714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/13/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91 STRAWBERRY HILL AVENUE
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
STAMFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06902-2745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-323-7041
Provider Business Mailing Address Fax Number:
914-761-3372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
91 STRAWBERRY HILL AVENUE
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
STAMFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06902-2745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-323-7041
Provider Business Practice Location Address Fax Number:
914-761-3372
Provider Enumeration Date:
09/13/2007

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: 104100000X , with the licence number:  1944 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 140001944CT01 . This is a "ANTHEM BLUE CROSS BLUE SH" identifier . This identifiers is of the category "OTHER".




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