Provider Demographics
NPI:1821108895
Name:O'CONNOR, LISA MARY (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:MARY
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 VALLEY RD
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:STIRLING
Mailing Address - State:NJ
Mailing Address - Zip Code:07980-1346
Mailing Address - Country:US
Mailing Address - Phone:908-647-1688
Mailing Address - Fax:908-647-5180
Practice Address - Street 1:1390 VALLEY RD
Practice Address - Street 2:SUITE 1E
Practice Address - City:STIRLING
Practice Address - State:NJ
Practice Address - Zip Code:07980-1346
Practice Address - Country:US
Practice Address - Phone:908-647-1688
Practice Address - Fax:908-647-5180
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05818600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health