Provider Demographics
NPI:1871780882
Name:O'CONNOR, TERESA L (LCSW-R)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 PINE ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14895-1421
Mailing Address - Country:US
Mailing Address - Phone:585-593-2261
Mailing Address - Fax:585-593-2261
Practice Address - Street 1:75 PINE ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14895-1421
Practice Address - Country:US
Practice Address - Phone:585-593-2261
Practice Address - Fax:585-593-2261
Is Sole Proprietor?:No
Enumeration Date:2007-10-03
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY084628-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health