Provider Demographics
NPI:1659584522
Name:O'CONNOR, LYNN VICTORIA (LCSW)
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:VICTORIA
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 1:75 VERONICA AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-5002
Mailing Address - Country:US
Mailing Address - Phone:732-447-3381
Mailing Address - Fax:732-821-0764
Practice Address - Street 1:75 VERONICA AVE STE 202
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-5002
Practice Address - Country:US
Practice Address - Phone:732-447-3381
Practice Address - Fax:732-821-0764
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2016-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053519001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ$$$$$$$$$OtherPRIVATE PRACTICE PROVIDER TAX ID
NJ135900BVEOtherINDIVIDUAL MEDICARE PTAN #
NJ527486OtherAGENCY MEDICARE NUMBER
NJ0023701Medicaid