Provider Demographics
NPI:1376060517
Name:O'CONNELL, PAIGE ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PAIGE
Middle Name:ELIZABETH
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:ELIZABETH
Other - Last Name:FRASER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2506 TASSAJARA AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1564
Mailing Address - Country:US
Mailing Address - Phone:626-524-9581
Mailing Address - Fax:
Practice Address - Street 1:2506 TASSAJARA AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1564
Practice Address - Country:US
Practice Address - Phone:626-524-9581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-28
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31769103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist