Provider Demographics
NPI:1447561451
Name:O'CONNOR, KIMBERLY A (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
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 1:1285 ROUTE 9
Mailing Address - Street 2:STE 7
Mailing Address - City:WAPPINGERS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12590-4993
Mailing Address - Country:US
Mailing Address - Phone:914-456-9637
Mailing Address - Fax:
Practice Address - Street 1:1133 ROUTE 55
Practice Address - Street 2:STE 2
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5051
Practice Address - Country:US
Practice Address - Phone:914-456-9637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0773031041C0700X
NY05320011041C0700X
NY21982291041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03336349Medicaid
NYA300049327Medicare PIN