Provider Demographics
NPI:1285229641
Name:O'CONNOR, BRIDGET MARY (LMSW)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:MARY
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LIBERTY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11703-4911
Mailing Address - Country:US
Mailing Address - Phone:315-727-9057
Mailing Address - Fax:
Practice Address - Street 1:32 LIBERTY AVE
Practice Address - Street 2:
Practice Address - City:NORTH BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11703-4911
Practice Address - Country:US
Practice Address - Phone:315-727-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-07
Last Update Date:2021-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106402-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker