Provider Demographics
NPI:1174274799
Name:MARY CATHERINE LCSW
Entity Type:Organization
Organization Name:MARY CATHERINE LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:CATHERINE
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:562-532-9811
Mailing Address - Street 1:375 REDONDO AVE # 310
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-8130
Mailing Address - Country:US
Mailing Address - Phone:562-532-9811
Mailing Address - Fax:
Practice Address - Street 1:6621 E PACIFIC COAST HWY STE 220
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4239
Practice Address - Country:US
Practice Address - Phone:562-532-9811
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2023-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty