Provider Demographics
NPI:1396955258
Name:O'CONNOR, JENNIFER LAFFERTY (PHD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAFFERTY
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ANN
Other - Last Name:LAFFERTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:616 S EL CAMINO REAL
Mailing Address - Street 2:SUITE G16
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4298
Mailing Address - Country:US
Mailing Address - Phone:949-292-9528
Mailing Address - Fax:
Practice Address - Street 1:616 S EL CAMINO REAL
Practice Address - Street 2:SUITE G16
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-4298
Practice Address - Country:US
Practice Address - Phone:949-292-9528
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24242103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical