Provider Demographics
NPI:1144672833
Name:CONLIFFE, MARIO (MS)
Entity type:Individual
Prefix:MR
First Name:MARIO
Middle Name:
Last Name:CONLIFFE
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4470 WOODSMAN DR
Mailing Address - Street 2:731
Mailing Address - City:HAMPSTEAD
Mailing Address - State:MD
Mailing Address - Zip Code:21074-3127
Mailing Address - Country:US
Mailing Address - Phone:240-319-3917
Mailing Address - Fax:
Practice Address - Street 1:1425 LIBERTY RD
Practice Address - Street 2:SUITE 206
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6420
Practice Address - Country:US
Practice Address - Phone:240-319-3917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-06
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP6839101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional