Provider Demographics
NPI:1154805182
Name:CONWAY, MARY SUZANNE
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:SUZANNE
Last Name:CONWAY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 HARVARD BUSINESS SCHOOL MAIL CTR
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02163-7803
Mailing Address - Country:US
Mailing Address - Phone:617-495-6831
Mailing Address - Fax:
Practice Address - Street 1:262 HARVARD BUSINESS SCHOOL MAIL CTR
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02163-7803
Practice Address - Country:US
Practice Address - Phone:617-495-6831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-15
Last Update Date:2018-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1011001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical