Provider Demographics
NPI:1962697714
Name:CONWAY, MADELINE WEISBERG (MSS LCSW)
Entity type:Individual
Prefix:MRS
First Name:MADELINE
Middle Name:WEISBERG
Last Name:CONWAY
Suffix:
Gender:F
Credentials:MSS LCSW
Other - Prefix:MRS
Other - First Name:MADGE
Other - Middle Name:
Other - Last Name:WEISBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSS LCSW
Mailing Address - Street 1:91 STRAWBERRY HILL AVENUE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-2745
Mailing Address - Country:US
Mailing Address - Phone:203-323-7041
Mailing Address - Fax:914-761-3372
Practice Address - Street 1:91 STRAWBERRY HILL AVENUE
Practice Address - Street 2:SUITE 140
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-2745
Practice Address - Country:US
Practice Address - Phone:203-323-7041
Practice Address - Fax:914-761-3372
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1944104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
140001944CT01OtherANTHEM BLUE CROSS BLUE SH