Provider Demographics
NPI:1770728776
Name:O'CONNOR, KATHLEEN MARY (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:MARY
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:KATY
Other - Middle Name:O'CONNOR
Other - Last Name:BRUNNER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:49 GILMAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLYOKE
Mailing Address - State:MA
Mailing Address - Zip Code:01040-2909
Mailing Address - Country:US
Mailing Address - Phone:413-654-6343
Mailing Address - Fax:
Practice Address - Street 1:49 GILMAN ST
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-2909
Practice Address - Country:US
Practice Address - Phone:413-654-6343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-05
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34005314A1041C0700X
MA1216351041C0700X
OHI.05000381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110148700AMedicaid