Provider Demographics
NPI:1720374879
Name:O'CONNELL, ERIN (EDS)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 SARANAC DR
Mailing Address - Street 2:
Mailing Address - City:WINTER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32708-5606
Mailing Address - Country:US
Mailing Address - Phone:904-349-1407
Mailing Address - Fax:
Practice Address - Street 1:644 SARANAC DR
Practice Address - Street 2:
Practice Address - City:WINTER SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32708-5606
Practice Address - Country:US
Practice Address - Phone:904-349-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-27
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS992103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool