Provider Demographics
NPI:1447793674
Name:CONLON, JOSEPH (LCSW)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:CONLON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 SOUNDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11731-1219
Mailing Address - Country:US
Mailing Address - Phone:631-860-8344
Mailing Address - Fax:
Practice Address - Street 1:74 SOUNDVIEW AVE
Practice Address - Street 2:
Practice Address - City:EAST NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11731-1219
Practice Address - Country:US
Practice Address - Phone:631-860-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-20
Last Update Date:2022-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098986-1104100000X
NY0902291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker