Provider Demographics
NPI:1104233386
Name:O'CONNOR, VANESSA (LCSW-C)
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:VANESSA
Other - Middle Name:
Other - Last Name:SIEMENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:6030 DAYBREAK CIR # A150-151
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21029-1642
Mailing Address - Country:US
Mailing Address - Phone:443-698-8406
Mailing Address - Fax:
Practice Address - Street 1:6030 DAYBREAK CIR # A150-151
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21029-1642
Practice Address - Country:US
Practice Address - Phone:443-698-8406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-19
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD181061041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical