Provider Demographics
NPI:1669687869
Name:O'CONNOR, ROBERT MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14464 N.E. 12TH PLACE
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4007
Mailing Address - Country:US
Mailing Address - Phone:425-747-7493
Mailing Address - Fax:206-296-1892
Practice Address - Street 1:1001 BROADWAY
Practice Address - Street 2:SUITE 315
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-4397
Practice Address - Country:US
Practice Address - Phone:206-296-5753
Practice Address - Fax:206-296-1892
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA588103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling