Provider Demographics
NPI:1194184416
Name:O'CONNOR, AMY (LMSW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WALKER ST
Mailing Address - Street 2:
Mailing Address - City:MALVERNE
Mailing Address - State:NY
Mailing Address - Zip Code:11565-1829
Mailing Address - Country:US
Mailing Address - Phone:718-938-3267
Mailing Address - Fax:516-599-3002
Practice Address - Street 1:20 WALKER ST
Practice Address - Street 2:
Practice Address - City:MALVERNE
Practice Address - State:NY
Practice Address - Zip Code:11565-1829
Practice Address - Country:US
Practice Address - Phone:718-938-3267
Practice Address - Fax:516-599-3002
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-15
Last Update Date:2016-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY096955104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker