Provider Demographics
NPI:1699731216
Name:CONAWAY, LARRY D (LCSW)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:D
Last Name:CONAWAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3549
Mailing Address - Country:US
Mailing Address - Phone:203-772-4228
Mailing Address - Fax:203-776-1982
Practice Address - Street 1:230 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3549
Practice Address - Country:US
Practice Address - Phone:203-772-4228
Practice Address - Fax:203-776-1982
Is Sole Proprietor?:No
Enumeration Date:2006-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00016331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical