Provider Demographics
NPI:1336487438
Name:O'CONNOR, MARY KIMBERLY (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KIMBERLY
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SONN DR
Mailing Address - Street 2:
Mailing Address - City:RYE
Mailing Address - State:NY
Mailing Address - Zip Code:10580-2531
Mailing Address - Country:US
Mailing Address - Phone:917-453-2328
Mailing Address - Fax:914-925-9839
Practice Address - Street 1:14 ELM PL STE 200
Practice Address - Street 2:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-24
Last Update Date:2019-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048401-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical