Healthcare Provider Details

I. General information

NPI: 1750340824
Provider Name (Legal Business Name): CRAIG MATTHEW CONOVER MS, LMHC, CAGS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2006
Last Update Date: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VIRGINIA AVE STE 105
PROVIDENCE RI
02905-4444
US

IV. Provider business mailing address

29 NIANTIC TRL
WEST GREENWICH RI
02817-1939
US

V. Phone/Fax

Practice location:
  • Phone: 508-979-5557
  • Fax:
Mailing address:
  • Phone: 401-397-8872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMHC00283
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: