MEDICARE: MS. KATHLEEN D CONWAY APRN, BC, CS

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	101YM0800X	Mental Health Counselor	APRN 002714	CT

General Provider Information

NPI Number	:	1376643205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KATHLEEN D CONWAY APRN, BC, CS

Provider Business Mailing Address
First Line	:	20 WOODBINE ST
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06853-1032
Country	:	US
Telephone Number	:	203-855-1185
Fax Number	:	203-854-5121

Provider Business Practice Location Address
First Line	:	20 WOODBINE ST
Second Line	:
City	:	NORWALK
State	:	CT
Zip	:	06853-1032
Country	:	US
Telephone Number	:	203-855-1185
Fax Number	:	203-854-5121

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

Provider Enumeration Date	:	09/22/2006
Last Update Date	:	07/08/2007

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