Provider Demographics
NPI:1659831956
Name:O'CONNOR, KAITLYN MARY (MSW)
Entity Type:Individual
Prefix:MISS
First Name:KAITLYN
Middle Name:MARY
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 WEST SIMSBURY ROAD
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:CT
Mailing Address - Zip Code:06019
Mailing Address - Country:US
Mailing Address - Phone:860-810-7224
Mailing Address - Fax:
Practice Address - Street 1:65 WEST SIMSBURY ROAD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:CT
Practice Address - Zip Code:06019-6424
Practice Address - Country:US
Practice Address - Phone:860-810-7224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-22
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7084104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker