Provider Demographics
NPI:1942348701
Name:O'CONNOR, ROBERT GARY (LICSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:GARY
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 BURT ST
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:MA
Mailing Address - Zip Code:02766-2569
Mailing Address - Country:US
Mailing Address - Phone:508-285-3370
Mailing Address - Fax:508-285-3373
Practice Address - Street 1:35 BURT ST
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:MA
Practice Address - Zip Code:02766-2569
Practice Address - Country:US
Practice Address - Phone:508-285-3370
Practice Address - Fax:508-285-3373
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1054421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP04032OtherBLUE CROSS BLUE SHIELD MA
MA292216OtherMANAGED HEALTH NETWORK
MA407701OtherBLUECHIP
MA22462-8OtherBLUE CROSS BLUE SHIELD RI
MA006571OtherVALUEOPTIONS HARVARD PILG
MA153711OtherVALUEOPTIONS
MA1853899Medicaid
MA44699OtherHORIZON
MA282815OtherAETNA
MA282815OtherMAGELLAN
MA410194OtherTUFTS
MA1853899Medicaid