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NPI Code Detail

MEDICARE: MR. PETER CONLIN LCSW

MEDICARE: MR. PETER CONLIN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker0904005758VA

General Provider Information

NPI Number : 1326135286
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. PETER CONLIN LCSW
Provider Business Mailing Address
First Line : 3735 HERITAGE RD SW
Second Line :
City : ROANOKE
State : VA
Zip : 24015-4517
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3033 PETERS CREEK RD NW
Second Line :
City : ROANOKE
State : VA
Zip : 24019-2738
Country : US
Telephone Number : 540-527-1504
Fax Number : 540-527-1506
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/10/2006
Last Update Date : 07/09/2007

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Directions to “ MR. PETER CONLIN LCSW” Practice Location

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