Provider Demographics
NPI:1770659682
Name:O'CONNELL, PATRICK THEODORE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:THEODORE
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3118 BLUE HERON ST
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-5304
Mailing Address - Country:US
Mailing Address - Phone:727-712-9327
Mailing Address - Fax:727-799-0191
Practice Address - Street 1:13575 58TH ST N
Practice Address - Street 2:SUITE 119
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33760-3740
Practice Address - Country:US
Practice Address - Phone:727-538-7714
Practice Address - Fax:727-799-0191
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5391103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59853Medicare ID - Type Unspecified
FLR33858Medicare UPIN