Provider Demographics
NPI:1952749277
Name:O'CONNELL, SYDNI (LEP, NCSP)
Entity Type:Individual
Prefix:MS
First Name:SYDNI
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LEP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 REVERE ST APT 108
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3064
Mailing Address - Country:US
Mailing Address - Phone:508-404-8796
Mailing Address - Fax:
Practice Address - Street 1:745 HIGH ST STE 204
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2535
Practice Address - Country:US
Practice Address - Phone:508-404-8796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-08
Last Update Date:2021-12-01
Deactivation Date:2021-11-11
Deactivation Code:
Reactivation Date:2021-12-01
Provider Licenses
StateLicense IDTaxonomies
222Q00000X
MA1221-MH-ED103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist