Provider Demographics
NPI:1972526226
Name:CONWAY, JAY EDWARD (MSW LCSW)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:EDWARD
Last Name:CONWAY
Suffix:
Gender:M
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:JAMES
Other - Middle Name:EDWARD
Other - Last Name:CONWAY
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:MSW LCSW
Mailing Address - Street 1:12 MAIN ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TOPSHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04086
Mailing Address - Country:US
Mailing Address - Phone:207-798-4800
Mailing Address - Fax:
Practice Address - Street 1:12 MAIN ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TOPSHAM
Practice Address - State:ME
Practice Address - Zip Code:04086
Practice Address - Country:US
Practice Address - Phone:207-798-4800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC11641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME5799251OtherAETNA
ME017167OtherANTHEM STAR #
ME5799251OtherAETNA