Provider Demographics
NPI:1376502252
Name:O CONNOR, MARIAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIAN
Middle Name:
Last Name:O CONNOR
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 1:555 BLOOMING GROVE TURNPIKE
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-7843
Mailing Address - Country:US
Mailing Address - Phone:845-562-0487
Mailing Address - Fax:845-238-5681
Practice Address - Street 1:555 BLOOMING GROVE TURNPIKE
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7843
Practice Address - Country:US
Practice Address - Phone:845-562-0487
Practice Address - Fax:845-238-5681
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR02426511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
7400120OtherGHI
N37741OtherEMPIRE BLUE CROSS
7400120OtherGHI