Provider Demographics
NPI:1144677626
Name:O'CONNELL, MARY RITA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:RITA
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 ANGELL ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-4467
Mailing Address - Country:US
Mailing Address - Phone:401-272-2250
Mailing Address - Fax:401-633-6676
Practice Address - Street 1:501 ANGELL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-4467
Practice Address - Country:US
Practice Address - Phone:401-272-2250
Practice Address - Fax:401-633-6676
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-16
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8022101YP2500X
RIMHC00826101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional