1922101419 NPI number — SHELLEY ANN O'CONNOR LCSW, MS

Table of content: SHELLEY ANN O'CONNOR LCSW, MS (NPI 1922101419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922101419 NPI number — SHELLEY ANN O'CONNOR LCSW, MS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'CONNOR
Provider First Name:
SHELLEY
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, MS
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:
1922101419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/10/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
690 212TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21122-1440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-508-1580
Provider Business Mailing Address Fax Number:
877-258-9432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
458 RITCHIE HIGHWAY
Provider Second Line Business Practice Location Address:
SUITE 203D
Provider Business Practice Location Address City Name:
SEVERNA PARK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-508-1580
Provider Business Practice Location Address Fax Number:
877-258-9432
Provider Enumeration Date:
09/07/2006

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: 1041C0700X , with the licence number:  CW015394 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 20748 , registered in the state of MD ; 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