Provider Demographics
NPI:1861860884
Name:O'CONNOR, STEPHEN S (PHD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:S
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 WOODMONT AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2784
Mailing Address - Country:US
Mailing Address - Phone:206-595-8615
Mailing Address - Fax:
Practice Address - Street 1:8120 WOODMONT AVE STE 205
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2784
Practice Address - Country:US
Practice Address - Phone:206-595-8615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-08
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1767103T00000X
MD06606103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist