MEDICARE: EMMA R CONQUEST

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	106S00000X	Behavior Technician		CT

General Provider Information

NPI Number	:	1801736640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA R CONQUEST

Provider Business Mailing Address
First Line	:	272 CONGDON ST
Second Line	:
City	:	MIDDLETOWN
State	:	CT
Zip	:	06457-2066
Country	:	US
Telephone Number	:	860-876-3672
Fax Number	:

Provider Business Practice Location Address
First Line	:	655 WINDING BROOK DR
Second Line	:
City	:	GLASTONBURY
State	:	CT
Zip	:	06033-4337
Country	:	US
Telephone Number	:	888-754-0398
Fax Number	:

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

Provider Enumeration Date	:	03/31/2026
Last Update Date	:	03/31/2026

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Directions to “ EMMA R CONQUEST ” Practice Location

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