1356779292 NPI number — MRS. JAMIE O'CONNOR MA, LPC

Table of content: MRS. JAMIE O'CONNOR MA, LPC (NPI 1356779292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356779292 NPI number — MRS. JAMIE O'CONNOR MA, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNOR
Provider First Name:
JAMIE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LICHTENBERG
Provider Other First Name:
JAMIE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356779292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2261
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07003-9061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
973-680-8388
Provider Business Mailing Address Fax Number:
973-680-8803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20 WATSESSING AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLOOMFIELD
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07003-4613
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
973-680-8388
Provider Business Practice Location Address Fax Number:
973-680-8803
Provider Enumeration Date:
10/30/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  37PC00387300 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)