Provider Demographics
NPI:1548327547
Name:OCONNELL, JAMES M (PHD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:OCONNELL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840
Mailing Address - Country:US
Mailing Address - Phone:732-548-6770
Mailing Address - Fax:732-549-8961
Practice Address - Street 1:171 MAIN STREET
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840
Practice Address - Country:US
Practice Address - Phone:732-548-6770
Practice Address - Fax:732-549-8961
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2658103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
247834000OtherMAGELLAN
10663174OtherCAQH
10663174OtherCAQH