Provider Demographics
NPI:1497396907
Name:CONAGHAN, MARYCLAIRE (LMSW)
Entity type:Individual
Prefix:
First Name:MARYCLAIRE
Middle Name:
Last Name:CONAGHAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:MARYCLAIRE
Other - Middle Name:
Other - Last Name:MOLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:225 BROADHOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-4822
Mailing Address - Country:US
Mailing Address - Phone:631-385-7780
Mailing Address - Fax:
Practice Address - Street 1:3635 BELL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-2097
Practice Address - Country:US
Practice Address - Phone:718-830-0246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NY123035104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician