Provider Demographics
NPI:1285215335
Name:M. KIM O'CONNOR, LCSW, PLLC
Entity Type:Organization
Organization Name:M. KIM O'CONNOR, LCSW, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:KIMBERLY
Authorized Official - Last Name:O'CONNOR
Authorized Official - Suffix:
Authorized Official - Credentials:LCWSW-R
Authorized Official - Phone:917-453-2328
Mailing Address - Street 1:14 ELM PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2951
Mailing Address - Country:US
Mailing Address - Phone:917-453-2328
Mailing Address - Fax:914-925-9839
Practice Address - Street 1:14 ELM PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:RYE
Practice Address - State:NY
Practice Address - Zip Code:10580-2951
Practice Address - Country:US
Practice Address - Phone:917-453-2328
Practice Address - Fax:914-925-9839
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty