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General NPI Number Information
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NPI Number | 1356916258
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Entity Type | Individual
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Provider Name | DOMINIQUE ROBIN PRICE CONLEY LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/24/2021
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Last Update Date | 05/24/2021
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Provider Practice Location Address
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Address Line | 110 LIVERMORE ST APT C10
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City | MATTAPAN
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State | MA
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Zip | 02126-1252
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Country | US
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Telephone | 617-413-7703
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Fax |
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Provider Business Mailing Address
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Address Line | 1 BOSTON MEDICAL CTR PL STE 1
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City | BOSTON
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State | MA
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Zip | 02118-2908
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Country | US
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Telephone | 617-414-8314
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number | 224776
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License Number State | MA
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