Basic Information
| Provider Information | |||||||||
| NPI: | 1497130785 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CONROY | ||||||||
| FirstName: | DAWN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 58 FREEMAN ST | ||||||||
| Address2: | 75-89 FLEMING AVENUE | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071054005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735964190 | ||||||||
| FaxNumber: | 9736396583 | ||||||||
| Practice Location | |||||||||
| Address1: | 590 N 7TH ST | ||||||||
| Address2: | ATTN :LAMONT SIMMONS | ||||||||
| City: | NEWARK | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 071072522 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9735965101 | ||||||||
| FaxNumber: | 9736395049 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2015 | ||||||||
| LastUpdateDate: | 07/28/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 44SL05922000 | NJ | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.