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General NPI Number Information
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NPI Number | 1255793782
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Entity Type | Organization
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Legal Business Name | PC PSYCHOTHERAPY
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/23/2016
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Provider Practice Location Address
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Address Line | 50 S MAIN ST SUITE 200
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City | NAPERVILLE
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State | IL
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Zip | 60540-5484
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Country | US
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Telephone | 630-292-0029
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Fax |
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Provider Business Mailing Address
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Address Line | 50 S MAIN ST SUITE 200
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City | NAPERVILLE
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State | IL
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Zip | 60540-5484
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Country | US
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Telephone | 630-292-0029
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ANGELA CONWAY
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Credential | PSY.D
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Telephone | 630-292-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.008483
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License Number State | IL
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