Provider Demographics
NPI:1386929966
Name:O'CONNOR, MARGIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARGIE
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 1:27172 WOODWARD AVE
Mailing Address - Street 2:#200
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067-0963
Mailing Address - Country:US
Mailing Address - Phone:248-546-0407
Mailing Address - Fax:248-546-1925
Practice Address - Street 1:27172 WOODWARD AVE
Practice Address - Street 2:#200
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48067-0963
Practice Address - Country:US
Practice Address - Phone:248-546-0407
Practice Address - Fax:248-546-1925
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801060979106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2487230845Medicare UPIN