Provider Demographics
NPI:1770879454
Name:OCONNOR, DEBBIE J (LCSW)
Entity type:Individual
Prefix:
First Name:DEBBIE
Middle Name:J
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:PO BOX 383
Mailing Address - Street 2:
Mailing Address - City:WAMPSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13163-0383
Mailing Address - Country:US
Mailing Address - Phone:315-440-4714
Mailing Address - Fax:
Practice Address - Street 1:4937 SPRING RD
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:NY
Practice Address - Zip Code:13478-3526
Practice Address - Country:US
Practice Address - Phone:315-361-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY251300000XMedicaid