Provider Demographics
NPI:1548283161
Name:O'CONNELL, JOAN (LICSW)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:
Last Name:O'CONNELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 EAST ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-3790
Mailing Address - Country:US
Mailing Address - Phone:413-461-6197
Mailing Address - Fax:857-244-6843
Practice Address - Street 1:401 EAST ST
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-3789
Practice Address - Country:US
Practice Address - Phone:413-461-6197
Practice Address - Fax:857-244-6843
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10235901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
P22913Medicare ID - Type Unspecified