Provider Demographics
NPI:1265449938
Name:OCONNOR, VIVIAN C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:VIVIAN
Middle Name:C
Last Name:OCONNOR
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 1:19 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-5728
Mailing Address - Country:US
Mailing Address - Phone:516-798-5365
Mailing Address - Fax:516-798-5365
Practice Address - Street 1:19 RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-5728
Practice Address - Country:US
Practice Address - Phone:516-798-5365
Practice Address - Fax:516-798-5365
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2008-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR03043111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N40721OtherEMPIRE BLUE CROSS BLUE SH
4353468OtherAETNA
SF0001416OtherSELECT PRO
7402592OtherGHI GROUP HEALTH INS
038203OtherVALUE OPTIONS
NY02051921Medicaid
141030000OtherMAGELLAN
038203OtherVALUE OPTIONS
N40721OtherEMPIRE BLUE CROSS BLUE SH