Provider Demographics
NPI:1417551805
Name:O'CONNOR, MARY CATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
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 1:1360 E ANAHEIM ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-5515
Mailing Address - Country:US
Mailing Address - Phone:562-270-0324
Mailing Address - Fax:562-285-7806
Practice Address - Street 1:1360 E ANAHEIM ST STE 101
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-5515
Practice Address - Country:US
Practice Address - Phone:562-270-0324
Practice Address - Fax:562-285-7806
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical