Provider Demographics
NPI:1841609708
Name:O'CONNOR, JOAN (LMHC)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:JOAN
Other - Middle Name:
Other - Last Name:NARDIELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 VILLAGE PLAZA
Mailing Address - Street 2:SUITE 302/304
Mailing Address - City:KINGS PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11754
Mailing Address - Country:US
Mailing Address - Phone:631-601-4829
Mailing Address - Fax:
Practice Address - Street 1:1 VILLAGE PLAZA
Practice Address - Street 2:SUITE 302/304
Practice Address - City:KINGS PARK
Practice Address - State:NY
Practice Address - Zip Code:11754
Practice Address - Country:US
Practice Address - Phone:631-601-4829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002079-1101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional