MEDICARE: ELAINE O'CONNELL

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

General Provider Information

NPI Number	:	1578935482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELAINE O'CONNELL

Provider Business Mailing Address
First Line	:	330 E 79TH ST
Second Line	:	APT. 1G
City	:	NEW YORK
State	:	NY
Zip	:	10075-0966
Country	:	US
Telephone Number	:	917-699-4256
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 E 79TH ST
Second Line	:	APT. 1G
City	:	NEW YORK
State	:	NY
Zip	:	10075-0966
Country	:	US
Telephone Number	:	917-699-4256
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. ELAINE O'CONNELL
Credential	:	LCSW
Telephone Number	:	917-699-4256

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	10/30/2015

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Directions to “ELAINE O'CONNELL ” Practice Location

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