Provider Demographics
NPI:1831589506
Name:O'CONNOR, SHERRI JEORJIA (LCSW, CAP)
Entity type:Individual
Prefix:
First Name:SHERRI JEORJIA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LCSW, CAP
Other - Prefix:
Other - First Name:JEORJIA
Other - Middle Name:ELIZABETH
Other - Last Name:O'CONNOR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, CAP
Mailing Address - Street 1:8018 B W STEVENSON RD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6132
Mailing Address - Country:US
Mailing Address - Phone:352-340-7816
Mailing Address - Fax:
Practice Address - Street 1:8080 B W STEVENSON RD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6132
Practice Address - Country:US
Practice Address - Phone:352-340-7816
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 121191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical