Healthcare Provider Details

I. General information

NPI: 1497396907
Provider Name (Legal Business Name): MARYCLAIRE CONAGHAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARYCLAIRE MOLEY

II. Dates (important events)

Enumeration Date: 10/06/2019
Last Update Date: 12/06/2024
Certification Date: 12/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3635 BELL BLVD STE 203
BAYSIDE NY
11361-2097
US

IV. Provider business mailing address

225 BROADHOLLOW RD
MELVILLE NY
11747-4822
US

V. Phone/Fax

Practice location:
  • Phone: 718-830-0246
  • Fax:
Mailing address:
  • Phone: 631-385-7780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123035
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: