Provider Demographics
NPI:1386286896
Name:O'CONNOR, MARISSA
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 TREMONT RD
Mailing Address - Street 2:
Mailing Address - City:LINDENHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11757-1734
Mailing Address - Country:US
Mailing Address - Phone:516-361-3576
Mailing Address - Fax:
Practice Address - Street 1:770 GRAND BLVD STE 17
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:NY
Practice Address - Zip Code:11729-5725
Practice Address - Country:US
Practice Address - Phone:516-361-3576
Practice Address - Fax:631-392-4358
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-16
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker