Provider Demographics
NPI:1043718620
Name:UPTOWN PSYCHOLOGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:UPTOWN PSYCHOLOGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:480-999-6020
Mailing Address - Street 1:PO BOX 1581
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85244-1581
Mailing Address - Country:US
Mailing Address - Phone:480-999-6020
Mailing Address - Fax:
Practice Address - Street 1:517 W JASPER DR
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85225-6542
Practice Address - Country:US
Practice Address - Phone:480-999-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4846103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4846OtherMEDICAL LICENSE