Provider Demographics
NPI:1083046205
Name:CONWAY, CHRISTOPHER (LADC 2)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:CONWAY
Suffix:
Gender:M
Credentials:LADC 2
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:432 DUDLEY ST STE 211
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-2763
Mailing Address - Country:US
Mailing Address - Phone:617-671-6918
Mailing Address - Fax:
Practice Address - Street 1:432 DUDLEY ST STE 211
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-2763
Practice Address - Country:US
Practice Address - Phone:617-671-6918
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)