Provider Demographics
NPI:1801559786
Name:O'CONNELL, ERIN LAUREN (MS)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LAUREN
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S BEDFORD RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT KISCO
Mailing Address - State:NY
Mailing Address - Zip Code:10549-3425
Mailing Address - Country:US
Mailing Address - Phone:914-330-4559
Mailing Address - Fax:
Practice Address - Street 1:183 FOREST BLVD
Practice Address - Street 2:
Practice Address - City:ARDSLEY
Practice Address - State:NY
Practice Address - Zip Code:10502-1036
Practice Address - Country:US
Practice Address - Phone:914-330-4559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-18
Last Update Date:2021-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP112003101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health