Healthcare Provider Details

I. General information

NPI: 1801432109
Provider Name (Legal Business Name): CONEN LICSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 11/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 COOK ST
NEWTON MA
02458-1311
US

IV. Provider business mailing address

59 COOK ST
NEWTON MA
02458-1311
US

V. Phone/Fax

Practice location:
  • Phone: 617-571-1156
  • Fax:
Mailing address:
  • Phone: 617-571-1156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MS. VALERIE F CONEN
Title or Position: CLINICAL SOCIAL WORKER
Credential: LICSW
Phone: 617-571-1156