Provider Demographics
NPI:1396263919
Name:O'CONNOR, SUZANNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:
Last Name:O'CONNOR
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 1:222 W THOMAS RD STE 401
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4423
Mailing Address - Country:US
Mailing Address - Phone:602-406-4373
Mailing Address - Fax:602-406-4406
Practice Address - Street 1:222 W THOMAS RD STE 401
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4423
Practice Address - Country:US
Practice Address - Phone:602-406-4373
Practice Address - Fax:602-406-4406
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-04
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4846103G00000X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist