Provider Demographics
NPI:1972099232
Name:O'CONNOR, ROBERT (LMSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 WOOD ST
Mailing Address - Street 2:
Mailing Address - City:LYNBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11563-2432
Mailing Address - Country:US
Mailing Address - Phone:516-361-9695
Mailing Address - Fax:
Practice Address - Street 1:8802 ROCKAWAY BLVD
Practice Address - Street 2:
Practice Address - City:ROCKAWAY BEACH
Practice Address - State:NY
Practice Address - Zip Code:11693
Practice Address - Country:US
Practice Address - Phone:718-634-3461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103835-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker