Provider Demographics
NPI:1902381429
Name:OCONNOR, SEAMUS (MA, MS, MT-BC)
Entity type:Individual
Prefix:
First Name:SEAMUS
Middle Name:
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:MA, MS, MT-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 GLEN ARBOR RD
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-4727
Mailing Address - Country:US
Mailing Address - Phone:215-847-8290
Mailing Address - Fax:
Practice Address - Street 1:450 PARK WAY
Practice Address - Street 2:
Practice Address - City:BROOMALL
Practice Address - State:PA
Practice Address - Zip Code:19008-4202
Practice Address - Country:US
Practice Address - Phone:610-732-8683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
09838225A00000X
PAPC011808101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist