Provider Demographics
NPI:1700343217
Name:OCONNOR, ROSEMARY E (LCSW)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:E
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 TRADEWINDS DR
Mailing Address - Street 2:
Mailing Address - City:BAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11709-3013
Mailing Address - Country:US
Mailing Address - Phone:631-524-1111
Mailing Address - Fax:
Practice Address - Street 1:50 GLEN ST STE 311
Practice Address - Street 2:
Practice Address - City:GLEN COVE
Practice Address - State:NY
Practice Address - Zip Code:11542-2701
Practice Address - Country:US
Practice Address - Phone:929-324-7717
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-21
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104319104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker