Provider Demographics
NPI:1720041163
Name:CASE, O'CONNELL W (LCSW)
Entity Type:Individual
Prefix:
First Name:O'CONNELL
Middle Name:W
Last Name:CASE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:803 N MONROE ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-3321
Mailing Address - Country:US
Mailing Address - Phone:812-332-1262
Mailing Address - Fax:812-334-8464
Practice Address - Street 1:803 N MONROE ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47404-3321
Practice Address - Country:US
Practice Address - Phone:812-332-1262
Practice Address - Fax:812-334-8464
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040052311041C0700X
IN34006579A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical