Provider Demographics
NPI:1710200118
Name:O'CONNELL, CHARLENE
Entity Type:Individual
Prefix:
First Name:CHARLENE
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 ROOT RD
Mailing Address - Street 2:SUITE #2
Mailing Address - City:WESTFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01085-9832
Mailing Address - Country:US
Mailing Address - Phone:413-568-3942
Mailing Address - Fax:
Practice Address - Street 1:209 ROOT RD
Practice Address - Street 2:SUITE #2
Practice Address - City:WESTFIELD
Practice Address - State:MA
Practice Address - Zip Code:01085-9832
Practice Address - Country:US
Practice Address - Phone:413-568-3942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-12
Last Update Date:2010-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator