Provider Demographics
NPI:1063968824
Name:CONROY, DAWN (LMSW)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:CONROY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:05055 BLUE STAR MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:SOUTH HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49090-7135
Mailing Address - Country:US
Mailing Address - Phone:269-767-1245
Mailing Address - Fax:269-637-7427
Practice Address - Street 1:05055 BLUE STAR MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:SOUTH HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49090-7135
Practice Address - Country:US
Practice Address - Phone:269-767-1245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-31
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010658541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical