Provider Demographics
NPI:1740158062
Name:O'CONNELL, RENEE MICHELLE
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:MICHELLE
Last Name:O'CONNELL
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 1:1120 E TWIGGS ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-3104
Mailing Address - Country:US
Mailing Address - Phone:802-774-8296
Mailing Address - Fax:
Practice Address - Street 1:109 N OAKWOOD AVE STE 105
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4629
Practice Address - Country:US
Practice Address - Phone:813-819-8704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW226561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical