Provider Demographics
NPI:1679876148
Name:O'CONNOR, MARGARET ELLEN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:MARGARET
Middle Name:ELLEN
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:ELLEN
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:33 ROUND HILL STREET
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:781-635-2318
Mailing Address - Fax:
Practice Address - Street 1:333 PAWTUCKET ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-3303
Practice Address - Country:US
Practice Address - Phone:781-635-2318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-06
Last Update Date:2010-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1117351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical