1023334794 NPI number — MRS. MARY ANNE O'CONNELL LMSW

Table of content: MRS. MARY ANNE O'CONNELL LMSW (NPI 1023334794)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023334794 NPI number — MRS. MARY ANNE O'CONNELL LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNELL
Provider First Name:
MARY ANNE
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023334794
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/20/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
118 FAIRVIEW ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48103-4024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-662-1959
Provider Business Mailing Address Fax Number:
734-662-1959

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2901 EASRT GRAND RIVER AVE
Provider Second Line Business Practice Location Address:
C/O PAM
Provider Business Practice Location Address City Name:
HOWELL
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48843
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-548-1537
Provider Business Practice Location Address Fax Number:
517-548-9399
Provider Enumeration Date:
04/20/2010

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: 101YM0800X , with the licence number:  6801085778 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 6801085778 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 6801085778 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6801085778 . This is a "MI STATE SOCIAL WORK LISCENSE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: SWL001523563 . This is a "PROFESSIONAL LIABILITY INSURANCE" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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