Provider Demographics
NPI:1386191898
Name:O'CONNOR, EDWARD SCOTT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SCOTT
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7031 108TH ST
Mailing Address - Street 2:APT. 14B
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4424
Mailing Address - Country:US
Mailing Address - Phone:917-617-7246
Mailing Address - Fax:
Practice Address - Street 1:7031 108TH ST
Practice Address - Street 2:APT. 14B
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4424
Practice Address - Country:US
Practice Address - Phone:917-617-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1387032103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool