Provider Demographics
NPI:1902939366
Name:O'CONNELL, DAVID F (PH D)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:F
Last Name:O'CONNELL
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:396 S CENTRE ST
Mailing Address - Street 2:STE 3A
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-3596
Mailing Address - Country:US
Mailing Address - Phone:570-622-2820
Mailing Address - Fax:
Practice Address - Street 1:396 S CENTRE ST
Practice Address - Street 2:STE 3A
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-3596
Practice Address - Country:US
Practice Address - Phone:570-622-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003726L103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA185836K34Medicare PIN