CHARLENE CONWAY (NPI# 1770018962) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1770018962 |
| Entity Type | Individual |
| Full Name | CHARLENE CONWAY |
| Credential | LPT |
| Practice Address |
2101 Courage Dr Fairfield CA 94533-6717 |
| Practice Telephone | 7076394675 |
| Mailing Telephone | 7076394675 |
| Enumeration Date | 2017-04-25 |
| Last Update Date | 2017-04-25 |
| Gender Code | F |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 167G00000X | Licensed Psychiatric Technician | 40381 | CA | Nursing Service Providers |
| Street Address |
2101 COURAGE DR |
| City | FAIRFIELD |
| State | CA |
| Zip Code | 94533-6717 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1396736732 | Sarah Jane Bolger | Nurse Practitioner | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2005-11-03 |
| 1235754706 | Armina Roseanna Delacruz | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-06-10 |
| 1043834955 | Rodney Ralls | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-06-05 |
| 1740800531 | Cleveland Anthony Thibodeaux IIi | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-04-21 |
| 1477173672 | Lauren Elayna Lopez | Case Manager/Care Coordinator | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-04-17 |
| 1497388763 | Edward Lusung Mendoza | Licensed Vocational Nurse | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-02-14 |
| 1598397655 | Pamela Monterrosa | Student in an Organized Health Care Education/Training Program | 2101 Courage Dr, Fairfield, CA 94533 | 2020-02-06 |
| 1205476801 | Lemuel Francis Constantino | Registered Nurse | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-01-10 |
| 1285273490 | Simone Lenore Adkins | Counselor | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2020-01-06 |
| 1376182857 | Sean Michael Maher | Registered Nurse | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2019-12-31 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609487347 | Shayondelice Sledge | Case Manager/Care Coordinator | 3001 N. Texas St., #27, Fairfield, CA 94533 | 2020-08-16 |
| 1508401191 | Tiffany Ann Garcia | Social Worker | 1301 Roman Way, Martinez, CA 94533 | 2019-11-07 |
| 1609424175 | Andrew Stephens | Student in an Organized Health Care Education/Training Program | Dgmc, 101 Bodin Cir, Fairfield, CA 94533 | 2019-08-28 |
| 1821645383 | Michelle Marie Hackett | Marriage & Family Therapist | 1745 Enterprise Dr., Bldg. 2, Ste 1a, Fairfield, CA 94533 | 2019-08-20 |
| 1780154369 | Maria Leonila Ramos Corpuz | Behavior Technician | 744 Empire Street Suite 160, Fairfield, CA 94533 | 2018-11-27 |
| 1629575303 | Jeanne Ann Kiernan | Dentist | 690 Airman Dr, Apo, AA 94533 | 2018-04-10 |
| 1629596820 | Max Kardos | Student in an Organized Health Care Education/Training Program | 801 Empire St., Fairfield, CA 94533 | 2017-09-07 |
| 1780119867 | Justin Denhart Dickson | Student in an Organized Health Care Education/Training Program | 101 Bodin Cir Fairfield Ca 94533, David Grant Medical Center, Fpo, AA 94533 | 2017-04-26 |
| 1639613409 | Behrooz Shafiezadeh | Marriage & Family Therapist | Caminar, 601 Madison Street, Suite D, Fairfield, CA 94533 | 2016-12-13 |
| 1427500164 | Tanya Ayers | Counselor | 801 Empire Street, Fairfield, CA 94533 | 2016-10-28 |
| Find all providers in zip 94533 | ||||
| Taxonomy Code | 167G00000X |
| Grouping | Nursing Service Providers |
| Classification | Licensed Psychiatric Technician |
| An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982203592 | Leahann Vedella | Licensed Psychiatric Technician | 2398 Flatley Cir, Fairfield, CA 94533-8921 | 2020-10-23 |
| 1508411943 | Jesusa Nina Jenin Rodgers | Licensed Psychiatric Technician | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2019-08-02 |
| 1265915698 | Amadu Bubass Kamara | Licensed Psychiatric Technician | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2018-09-12 |
| 1538648910 | Arianne Summers | Licensed Psychiatric Technician | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2018-08-07 |
| 1356820732 | Anita Rose Hagewood | Licensed Psychiatric Technician | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2018-08-07 |
| 1841785128 | Chelsea Taylor Delos Santos | Licensed Psychiatric Technician | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2018-06-28 |
| 1962997486 | Paige Donovan | Licensed Psychiatric Technician | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2018-06-27 |
| 1851804421 | Aaron Lopez | Licensed Psychiatric Technician | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2017-11-06 |
| 1366974156 | Jennifer Gilley | Licensed Psychiatric Technician | 2101 Courage Dr, Fairfield, CA 94533-6717 | 2017-03-30 |
| 1548301732 | Joyce Louise Papetti Thompson | Licensed Psychiatric Technician | 2101 Courage Drive, Fairfield, CA 94533-6717 | 2007-02-09 |
| Find all providers in FAIRFIELD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.