MEDICARE: NATASHA MEDEIROS CONLEY, PSY.D., LLC

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	103T00000X	Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1659636975	OTHER		NPI

General Provider Information

NPI Number	:	1770048183
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATASHA MEDEIROS CONLEY, PSY.D., LLC

Provider Business Mailing Address
First Line	:	206 PLEASANT ST
Second Line	:
City	:	MILLIS
State	:	MA
Zip	:	02054-1720
Country	:	US
Telephone Number	:	774-263-1284
Fax Number	:	508-422-0261

Provider Business Practice Location Address
First Line	:	288 WEST ST STE 3B
Second Line	:
City	:	MILFORD
State	:	MA
Zip	:	01757-1234
Country	:	US
Telephone Number	:	508-794-5093
Fax Number	:	508-422-0261

Authorized Official
Title or Position	:	OWNER/CLINICAL PSYCHOLOGIST
Name	:	DR. NATASHA MEDEIROS CONLEY
Credential	:	PSY.D.
Telephone Number	:	774-263-1284

Provider Enumeration Date	:	02/11/2019
Last Update Date	:	02/11/2019

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