Healthcare Provider Details

I. General information

NPI: 1184358095
Provider Name (Legal Business Name): KIMBERLY MARIE CONLEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KIMBERLY MARIE PHILLIPS

II. Dates (important events)

Enumeration Date: 07/15/2022
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 WATER ST
CONNEAUT LAKE PA
16316-7279
US

IV. Provider business mailing address

675 WATER ST
CONNEAUT LAKE PA
16316-7229
US

V. Phone/Fax

Practice location:
  • Phone: 814-282-9913
  • Fax:
Mailing address:
  • Phone: 814-282-9913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW025314
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: