Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 20042060A | IN |
Y | 103TC0700X | Clinical Psychologist | 20042060A | IN |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 20042060A | IN |
NPI | 1043282098 |
---|---|
Provider Name | Dr. Anne Katherine Conley-Goldstein |
First Address | Avon, IN 46123-8923 |
Second Address | Avon, IN 46123-8923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 08/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200813210 | (05) | IN |