Provider Demographics
NPI:1689891665
Name:O'CONNELL, WILLIAM JOHN (MA, CAGS)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JOHN
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:MA, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:634 WHITE SETTLEMENT RD
Mailing Address - Street 2:
Mailing Address - City:HODGDON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-4434
Mailing Address - Country:US
Mailing Address - Phone:207-532-3118
Mailing Address - Fax:207-532-3118
Practice Address - Street 1:634 WHITE SETTLEMENT RD
Practice Address - Street 2:
Practice Address - City:HODGDON
Practice Address - State:ME
Practice Address - Zip Code:04730-4434
Practice Address - Country:US
Practice Address - Phone:207-532-3118
Practice Address - Fax:207-532-3118
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPE805103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME21181000099Medicaid