1689836827 NPI number — MRS. JACQUELYN MARIE O'CONNOR LICSW

Table of content: MRS. JACQUELYN MARIE O'CONNOR LICSW (NPI 1689836827)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689836827 NPI number — MRS. JACQUELYN MARIE O'CONNOR LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNOR
Provider First Name:
JACQUELYN
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
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:
1689836827
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
452 OLD STREET RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PETERBOROUGH
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03458
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-924-4699
Provider Business Mailing Address Fax Number:
603-924-4667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 N SOUTHWOOD DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHUA
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-880-1590
Provider Business Practice Location Address Fax Number:
603-880-1598
Provider Enumeration Date:
06/30/2008

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com