Provider Demographics
NPI:1902259732
Name:O'CONNOR, LAURIE-ANN
Entity Type:Individual
Prefix:DR
First Name:LAURIE-ANN
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:871 VENETIA BAY BLVD
Mailing Address - Street 2:SUITE 360
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-8047
Mailing Address - Country:US
Mailing Address - Phone:941-228-4090
Mailing Address - Fax:
Practice Address - Street 1:871 VENETIA BAY BLVD
Practice Address - Street 2:SUITE 360
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-8047
Practice Address - Country:US
Practice Address - Phone:941-228-4090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-17
Last Update Date:2016-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH 11172101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health