Doctor Name: | ANDREA SUSAN CONLON |
NPI Number: | 1134130180 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LICSW |
License Number: | LW00005053 |
Business Practice Address: | 355 Ericksen Ave Ne Suite 423 Bainbridge Island, WA - 981101889 |
Business Phone Number: | 2062768767 |
Business Fax Number: | |
Mailing Address: | 7530 Ne Jade Ln, BAINBRIDGE ISLAND |
State: | WA |
Postal Code: | 981102052 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 08/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LW00005053 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |