Basic Information
| Provider Information | |||||||||
| NPI: | 1598360398 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CONWAY | ||||||||
| FirstName: | ALISSA | ||||||||
| MiddleName: | ANNE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2 LARKSPUR LN | ||||||||
| Address2: | |||||||||
| City: | COLLEGEVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194263932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5705046570 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 170 N HENDERSON RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | KING OF PRUSSIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194062155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8563460005 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2020 | ||||||||
| LastUpdateDate: | 12/01/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.