Provider Demographics
NPI:1164873329
Name:O'CONNOR, TRISH (LCSW)
Entity Type:Individual
Prefix:
First Name:TRISH
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 SOQUEL AVE STE 260
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-2340
Mailing Address - Country:US
Mailing Address - Phone:831-818-9944
Mailing Address - Fax:
Practice Address - Street 1:555 SOQUEL AVE STE 260
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2340
Practice Address - Country:US
Practice Address - Phone:831-818-9944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 121291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical