Provider Demographics
NPI:1902180417
Name:O'CONNELL, PATTY A (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PATTY
Middle Name:A
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8336 BEVERLY RD APT 6B
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-1710
Mailing Address - Country:US
Mailing Address - Phone:207-505-2767
Mailing Address - Fax:
Practice Address - Street 1:8336 BEVERLY RD APT 6B
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-1710
Practice Address - Country:US
Practice Address - Phone:207-505-2767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-03
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC144071041C0700X
NY085386104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical