Provider Demographics
NPI:1811147374
Name:CONWAY, JILL (LCSW)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:
Last Name:CONWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 SCHOOL ST
Mailing Address - Street 2:SUITE LOWER LEVEL
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2952
Mailing Address - Country:US
Mailing Address - Phone:914-714-1969
Mailing Address - Fax:
Practice Address - Street 1:16 SCHOOL ST
Practice Address - Street 2:SUITE LOWER LEVEL
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2952
Practice Address - Country:US
Practice Address - Phone:914-714-1969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-22
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300118969Medicare PIN