Provider Demographics
NPI:1154407583
Name:O'CONNELL, CAROL L (PSYD)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N GREEN VALLEY PKWY
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-5885
Mailing Address - Country:US
Mailing Address - Phone:702-650-0590
Mailing Address - Fax:702-650-0591
Practice Address - Street 1:1701 N GREEN VALLEY PKWY
Practice Address - Street 2:SUITE 2A
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-5885
Practice Address - Country:US
Practice Address - Phone:702-650-0590
Practice Address - Fax:702-650-0591
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2010-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0608103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2540432Medicaid
OH2540432Medicaid