MEDICARE: ANDREA JEANNE O'CONNELL PLMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	PLMSW	AR

General Provider Information

NPI Number	:	1518852102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA JEANNE O'CONNELL PLMSW

Provider Business Mailing Address
First Line	:	247 TATER HILL RD
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-9634
Country	:	US
Telephone Number	:	860-681-5402
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 S ELM ST STE B
Second Line	:
City	:	SEARCY
State	:	AR
Zip	:	72143-6604
Country	:	US
Telephone Number	:	501-232-2600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2025
Last Update Date	:	06/12/2025

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