Provider Demographics
NPI:1659451763
Name:O'CONNELL, ANN E (MED; MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:ANN
Middle Name:E
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MED; MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 CHETWYND RD
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-1218
Mailing Address - Country:US
Mailing Address - Phone:617-625-4638
Mailing Address - Fax:
Practice Address - Street 1:361 MASSACHUSETTS AVE
Practice Address - Street 2:01-03
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6719
Practice Address - Country:US
Practice Address - Phone:781-646-9232
Practice Address - Fax:781-646-9230
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1021861-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical