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General NPI Number Information
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NPI Number | 1205747003
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Entity Type | Individual
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Provider Name | TARA MICHELLE CONWAY LMFTA
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Gender | Female
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 107 CHURCH HILL RD STE 1A
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City | SANDY HOOK
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State | CT
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Zip | 06482-1194
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Country | US
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Telephone | 475-323-2200
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Fax | 475-323-2200
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Provider Business Mailing Address
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Address Line | 1 BOTSFORD HILL RD # 756
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City | BOTSFORD
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State | CT
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Zip | 06404-9991
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Country | US
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Telephone | 203-451-1062
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 3939
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License Number State | CT
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