Provider Demographics
NPI:1316084817
Name:O'CONNELL, CATHERINE S (PHD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:S
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550N CENTRAL AVE 1407
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2112
Mailing Address - Country:US
Mailing Address - Phone:602-216-6900
Mailing Address - Fax:602-371-9889
Practice Address - Street 1:3550N CENTRAL AVE 1407
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2112
Practice Address - Country:US
Practice Address - Phone:602-216-6900
Practice Address - Fax:602-371-9889
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ830103G00000X, 103T00000X, 103TA0400X, 103TB0200X, 103TC0700X, 103TF0200X, 103TH0100X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ29563Medicare ID - Type Unspecified
AZR61062Medicare UPIN