Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 37PC00484600 | NJ |
N | 101YS0200X | School Counselor | NJ |
NPI | 1205598356 |
---|---|
Provider Name | Mr. Timothy Conway |
First Address | Riverdale, NJ 07457-1642 |
Second Address | Riverdale, NJ 07457-1642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2021 |
Last Update Date | 27/12/2021 |