Provider Demographics
NPI:1952443558
Name:OCONNOR, JOANNE I (LCSW SOCIAL WORKER)
Entity Type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:I
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:LCSW SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 BROADWAY AVENUE SUITE 5
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741
Mailing Address - Country:US
Mailing Address - Phone:631-689-8633
Mailing Address - Fax:
Practice Address - Street 1:800 BROADWAY AVENUE SUITE 5
Practice Address - Street 2:
Practice Address - City:HOLBROOK
Practice Address - State:NY
Practice Address - Zip Code:11741
Practice Address - Country:US
Practice Address - Phone:631-689-8633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0352711103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7A191Medicare ID - Type Unspecified