Provider Demographics
NPI:1134969785
Name:O'CONNOR, KELSI (LCSW, NREMT)
Entity type:Individual
Prefix:
First Name:KELSI
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LCSW, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1402 B ST
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2544
Mailing Address - Country:US
Mailing Address - Phone:202-524-3946
Mailing Address - Fax:
Practice Address - Street 1:1402 B ST
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2544
Practice Address - Country:US
Practice Address - Phone:202-524-3946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-30
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC062362001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty