Provider Demographics
NPI:1396874467
Name:O'CONNOR, JOHN ROBERT (LISW, ACSW)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:ROBERT
Last Name:O'CONNOR
Suffix:
Gender:M
Credentials:LISW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12417 CEDAR RD
Mailing Address - Street 2:STE 23
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44106-3157
Mailing Address - Country:US
Mailing Address - Phone:216-229-2100
Mailing Address - Fax:
Practice Address - Street 1:12417 CEDAR RD
Practice Address - Street 2:STE 23
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44106-3157
Practice Address - Country:US
Practice Address - Phone:216-229-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-00044971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOCSW12391Medicare ID - Type UnspecifiedPROVIDER NUMBER