Provider Demographics
NPI:1083852073
Name:O'CONNOR, LINDA ROSE (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:ROSE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-3106
Mailing Address - Country:US
Mailing Address - Phone:617-364-7276
Mailing Address - Fax:
Practice Address - Street 1:10 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-3106
Practice Address - Country:US
Practice Address - Phone:617-364-7276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA70010000LM0486OtherBLUE CROSS BLUE SHEILD OF MA