Organization
PC PSYCHOTHERAPY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANGELA CONWAY PSY.D (PRESIDENT)
(630) 292-0029
Entity
Organization
Contact information
Practice address
50 S MAIN ST, SUITE 200, NAPERVILLE, IL 60540-5484
(630) 292-0029
Mailing address
50 S MAIN ST, SUITE 200, NAPERVILLE, IL 60540-5484
(630) 292-0029
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
071.008483
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
F300213038
MEDICARE PTAN NUMBER
—
Enumeration date
03/23/2016
Last updated
03/23/2016
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