Provider Demographics
NPI:1548592009
Name:OCONNELL, ELISE (LICSW)
Entity Type:Individual
Prefix:
First Name:ELISE
Middle Name:
Last Name:OCONNELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 E BIRCH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3205
Mailing Address - Country:US
Mailing Address - Phone:773-349-6778
Mailing Address - Fax:
Practice Address - Street 1:231 CHESTNUT
Practice Address - Street 2:MEZZANINE
Practice Address - City:MEADVILLLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3342
Practice Address - Country:US
Practice Address - Phone:814-807-1300
Practice Address - Fax:814-807-1309
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-09
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical