Provider Demographics
NPI:1831231232
Name:CONRAD, CECILY C (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:CECILY
Middle Name:C
Last Name:CONRAD
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:MISS
Other - First Name:CECILY
Other - Middle Name:HELEN
Other - Last Name:CANDEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3417 ROBERTSON RD
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226
Mailing Address - Country:US
Mailing Address - Phone:360-384-2884
Mailing Address - Fax:
Practice Address - Street 1:1201 11TH ST
Practice Address - Street 2:SUITE 200B
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-223-5736
Practice Address - Fax:360-715-3657
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00006171103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8856593Medicare ID - Type Unspecified