Provider Demographics
NPI:1881023083
Name:O'CONNELL, GYNA MARITZA (MS, MHC)
Entity Type:Individual
Prefix:MS
First Name:GYNA
Middle Name:MARITZA
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MS, MHC
Other - Prefix:
Other - First Name:GYNA
Other - Middle Name:
Other - Last Name:MENESES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS MHC, LPC-IT
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1050 E BROADWAY
Practice Address - Street 2:
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4023
Practice Address - Country:US
Practice Address - Phone:608-287-5757
Practice Address - Fax:608-222-8944
Is Sole Proprietor?:No
Enumeration Date:2013-11-07
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
WI6142101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health