Provider Demographics
NPI:1871650838
Name:O'CONNELL, LEILA KATHRYN (MSW)
Entity Type:Individual
Prefix:
First Name:LEILA
Middle Name:KATHRYN
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1221
Mailing Address - Country:US
Mailing Address - Phone:401-749-6643
Mailing Address - Fax:
Practice Address - Street 1:144 WATERMAN ST STE 1
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2126
Practice Address - Country:US
Practice Address - Phone:401-421-1958
Practice Address - Fax:401-421-0015
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW014971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI007050018Medicare ID - Type Unspecified