Healthcare Provider Details

I. General information

NPI: 1700700317
Provider Name (Legal Business Name): MISS CLAIRE CONAHAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2026
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 TRINITY PL APT 403
MONTCLAIR NJ
07042-2758
US

IV. Provider business mailing address

25 TRINITY PL APT 403
MONTCLAIR NJ
07042-2758
US

V. Phone/Fax

Practice location:
  • Phone: 973-224-8170
  • Fax:
Mailing address:
  • Phone: 973-224-8170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00912300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: