Healthcare Provider Details

I. General information

NPI: 1205747003
Provider Name (Legal Business Name): TARA MICHELLE CONWAY LMFTA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 CHURCH HILL RD STE 1A
SANDY HOOK CT
06482-1194
US

IV. Provider business mailing address

1 BOTSFORD HILL RD # 756
BOTSFORD CT
06404-9991
US

V. Phone/Fax

Practice location:
  • Phone: 475-323-2200
  • Fax: 475-323-2200
Mailing address:
  • Phone: 203-451-1062
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3939
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: