Provider Demographics
NPI:1538288931
Name:O'CONNOR, JOAN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JOAN
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 1:350 W 20TH ST
Mailing Address - Street 2:APARTMENT 3R
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-3348
Mailing Address - Country:US
Mailing Address - Phone:212-627-3306
Mailing Address - Fax:
Practice Address - Street 1:344 W 36TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7598
Practice Address - Country:US
Practice Address - Phone:212-560-6700
Practice Address - Fax:212-244-2034
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0741941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNOH3201882Medicare ID - Type Unspecified