Provider Demographics
NPI:1962980375
Name:O'CONNOR, MAEVE (LICSW)
Entity type:Individual
Prefix:
First Name:MAEVE
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 RANTOUL ST UNIT 511
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-4275
Mailing Address - Country:US
Mailing Address - Phone:845-750-9975
Mailing Address - Fax:
Practice Address - Street 1:1 SALEM GRN STE 408
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-3790
Practice Address - Country:US
Practice Address - Phone:978-825-2020
Practice Address - Fax:978-741-8567
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119560104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker