Provider Demographics
NPI:1912073446
Name:CONLEY, MARY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:ANN
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5800 MCLEOD NE
Mailing Address - Street 2:STE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108
Mailing Address - Country:US
Mailing Address - Phone:505-888-4445
Mailing Address - Fax:505-888-0624
Practice Address - Street 1:5800 MCLEOD NE
Practice Address - Street 2:STE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108
Practice Address - Country:US
Practice Address - Phone:505-888-4445
Practice Address - Fax:505-888-0624
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NMNM462103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMND401Medicaid