Provider Demographics
NPI:1033776695
Name:CONROY, COLLEEN H (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:H
Last Name:CONROY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 THOMPSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-7740
Mailing Address - Country:US
Mailing Address - Phone:203-710-0116
Mailing Address - Fax:
Practice Address - Street 1:35 OLD TAVERN RD UNIT 120
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3450
Practice Address - Country:US
Practice Address - Phone:203-553-9949
Practice Address - Fax:203-553-9946
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-20
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0087261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039244Medicaid