Provider Demographics
NPI:1487896379
Name:CONWAY, KAREN B (PHD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:B
Last Name:CONWAY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 VAN NUYS BLVD STE 460
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1793
Mailing Address - Country:US
Mailing Address - Phone:818-994-9400
Mailing Address - Fax:818-905-7397
Practice Address - Street 1:5000 VAN NUYS BLVD STE 460
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1793
Practice Address - Country:US
Practice Address - Phone:818-994-9400
Practice Address - Fax:818-905-7397
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-24
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-08-4304103K00000X
CAPSY8501103TC0700X, 103TC2200X, 103TF0000X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities