Provider Demographics
NPI:1669937397
Name:O'CONNELL, BRENDAN (LCSW)
Entity type:Individual
Prefix:
First Name:BRENDAN
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 BAY AVE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4019
Mailing Address - Country:US
Mailing Address - Phone:631-678-2802
Mailing Address - Fax:
Practice Address - Street 1:55 CARLETON AVE STE 5
Practice Address - Street 2:
Practice Address - City:EAST ISLIP
Practice Address - State:NY
Practice Address - Zip Code:11730-2133
Practice Address - Country:US
Practice Address - Phone:631-579-3503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-06
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0857721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical