Healthcare Provider Details

I. General information

NPI: 1689062192
Provider Name (Legal Business Name): JOSEPH CONLON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2015
Last Update Date: 01/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 1ST ST SE
WASHINGTON DC
20303-0001
US

IV. Provider business mailing address

1200 1ST ST SE
WASHINGTON DC
20303-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-442-5885
  • Fax:
Mailing address:
  • Phone: 202-442-5885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number156851
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: