Provider Demographics
NPI:1720087117
Name:OCONNELL, GEOFFREY THOMAS (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:GEOFFREY
Middle Name:THOMAS
Last Name:OCONNELL
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 RING CIRCLE
Mailing Address - Street 2:SOCIAL WORK SUITE
Mailing Address - City:PORT JEFFERSON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-444-4343
Mailing Address - Fax:
Practice Address - Street 1:96 RING CIRCLE
Practice Address - Street 2:SOCIAL WORK SUITE
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3450
Practice Address - Country:US
Practice Address - Phone:631-444-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY473421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN47342Medicare PIN