Provider Demographics
NPI:1073735502
Name:JOHN O'CONNOR, PSY.D., LLC.
Entity Type:Organization
Organization Name:JOHN O'CONNOR, PSY.D., LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:OCONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:609-758-1237
Mailing Address - Street 1:PO BOX 236
Mailing Address - Street 2:
Mailing Address - City:NEW EGYPT
Mailing Address - State:NJ
Mailing Address - Zip Code:08533-0236
Mailing Address - Country:US
Mailing Address - Phone:609-758-1237
Mailing Address - Fax:609-758-7255
Practice Address - Street 1:54 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW EGYPT
Practice Address - State:NJ
Practice Address - Zip Code:08533-1413
Practice Address - Country:US
Practice Address - Phone:609-758-1237
Practice Address - Fax:609-758-7255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00437800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty