Provider Demographics
NPI:1689836827
Name:O'CONNOR, JACQUELYN MARIE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELYN
Middle Name:MARIE
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 OLD STREET RD
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458
Mailing Address - Country:US
Mailing Address - Phone:603-924-4699
Mailing Address - Fax:603-924-4667
Practice Address - Street 1:11 N SOUTHWOOD DR
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03063
Practice Address - Country:US
Practice Address - Phone:603-880-1590
Practice Address - Fax:603-880-1598
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker