Provider Demographics
NPI:1255495099
Name:O'CONNOR, CANDICE L (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CANDICE
Middle Name:L
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 1:9302 RIDGE BLVD
Mailing Address - Street 2:5B
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-6753
Mailing Address - Country:US
Mailing Address - Phone:718-833-3884
Mailing Address - Fax:
Practice Address - Street 1:7609 4TH AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3238
Practice Address - Country:US
Practice Address - Phone:718-288-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0755011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical