Provider Demographics
NPI:1861543555
Name:CONLEY, LOUISE M (PHD)
Entity type:Individual
Prefix:
First Name:LOUISE
Middle Name:M
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LOUISE
Other - Middle Name:M
Other - Last Name:CONLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:497 PROSPECT AVE.
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-4078
Mailing Address - Country:US
Mailing Address - Phone:609-497-1792
Mailing Address - Fax:
Practice Address - Street 1:497 PROSPECT AVE.
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-497-1792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2010-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ355100156300103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0137804Medicaid
NJ0137804Medicaid