Provider Demographics
NPI:1891178083
Name:O'CONNELL, ELISABETH (LCSW-R)
Entity Type:Individual
Prefix:
First Name:ELISABETH
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1321
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12402-1321
Mailing Address - Country:US
Mailing Address - Phone:646-847-9395
Mailing Address - Fax:
Practice Address - Street 1:19910 MALVERN RD
Practice Address - Street 2:
Practice Address - City:SHAKER HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44122-2823
Practice Address - Country:US
Practice Address - Phone:646-847-9395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-07
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY0878641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical