Provider Demographics
NPI:1598404626
Name:O'CONNOR, KERSTIN MARGIT (MSW LSW)
Entity Type:Individual
Prefix:MS
First Name:KERSTIN
Middle Name:MARGIT
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4134 N CLARENDON AVE APT 2N
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4935
Mailing Address - Country:US
Mailing Address - Phone:309-472-5758
Mailing Address - Fax:
Practice Address - Street 1:4134 N CLARENDON AVE APT 2N
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4935
Practice Address - Country:US
Practice Address - Phone:309-472-5758
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.1018711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty