Provider Demographics
NPI:1497227938
Name:OCONNOR, JAMES EDWARD (LICSW)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 SHERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3308
Mailing Address - Country:US
Mailing Address - Phone:508-655-3880
Mailing Address - Fax:
Practice Address - Street 1:21 SHERWOOD RD
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3308
Practice Address - Country:US
Practice Address - Phone:508-655-3880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10234571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1023457OtherMASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE