Provider Demographics
NPI:1992047500
Name:CONWAY, JERRY JOSEPH (LCSW)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:JOSEPH
Last Name:CONWAY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6111 ELIZAN DR NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-9617
Mailing Address - Country:US
Mailing Address - Phone:415-994-8238
Mailing Address - Fax:
Practice Address - Street 1:6111 ELIZAN DR NW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-9617
Practice Address - Country:US
Practice Address - Phone:415-994-8238
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical