MEDICARE: CAROLINE CONLEY MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC6075	CA

General Provider Information

NPI Number	:	1114135506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE CONLEY MFT

Provider Business Mailing Address
First Line	:	PO BOX 1279
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91614-0279
Country	:	US
Telephone Number	:	818-506-4452
Fax Number	:	818-506-4472

Provider Business Practice Location Address
First Line	:	12444 VENTURA BLVD
Second Line	:	#208
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2409
Country	:	US
Telephone Number	:	818-506-4452
Fax Number	:	818-506-4472

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2007
Last Update Date	:	07/08/2007

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Directions to “ CAROLINE CONLEY MFT” Practice Location

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