Provider Demographics
NPI:1548089725
Name:CONQUEST THERAPY, LCSW, PLLC
Entity type:Organization
Organization Name:CONQUEST THERAPY, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:716-272-2208
Mailing Address - Street 1:4125 SALISBURY RD
Mailing Address - Street 2:
Mailing Address - City:BEMUS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:14712-9747
Mailing Address - Country:US
Mailing Address - Phone:716-272-2208
Mailing Address - Fax:
Practice Address - Street 1:4125 SALISBURY RD
Practice Address - Street 2:
Practice Address - City:BEMUS POINT
Practice Address - State:NY
Practice Address - Zip Code:14712-9747
Practice Address - Country:US
Practice Address - Phone:716-272-2208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JULIA PAULSON COUNSELING AND THERAPY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty