Healthcare Provider Details

I. General information

NPI: 1457550980
Provider Name (Legal Business Name): MAURA CONRY LCSW, LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARY BYRNE CONRY LCSW, LSCSW

II. Dates (important events)

Enumeration Date: 07/14/2007
Last Update Date: 08/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7923 HALSEY ST
SHAWNEE MISSION KS
66215-2718
US

IV. Provider business mailing address

7923 HALSEY ST
SHAWNEE MISSION KS
66215-2718
US

V. Phone/Fax

Practice location:
  • Phone: 913-599-4469
  • Fax: 913-599-4469
Mailing address:
  • Phone: 913-599-4469
  • Fax: 913-599-4469

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2114
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2000171094
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: