Provider Demographics
NPI:1528239480
Name:CONATY, JENNIFER (PHD, HSP-P)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:CONATY
Suffix:
Gender:F
Credentials:PHD, HSP-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9251 COUNT FLEET DR
Mailing Address - Street 2:#101
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-6224
Mailing Address - Country:US
Mailing Address - Phone:703-731-4584
Mailing Address - Fax:
Practice Address - Street 1:9251 COUNT FLEET DR
Practice Address - Street 2:#101
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-6224
Practice Address - Country:US
Practice Address - Phone:703-731-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3473103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent