Basic Information
| Provider Information | |||||||||
| NPI: | 1972601375 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONWAY | ||||||||
| FirstName: | MARIANNE | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 CHRISTINA LANE | ||||||||
| Address2: | |||||||||
| City: | SANDWICH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02563 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084206883 | ||||||||
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| Practice Location | |||||||||
| Address1: | BAYVIEW ASSOCIATES/SOUTH SHORE MENTAL HEALTH | ||||||||
| Address2: | 310 BARNSTABLE ROAD | ||||||||
| City: | HYANNIS | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02601 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5088620514 | ||||||||
| FaxNumber: | 5088629184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.