Healthcare Provider Details

I. General information

NPI: 1912048422
Provider Name (Legal Business Name): CATHERINE S. O'CONNELL, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 N 16TH ST SUITE 219
PHOENIX AZ
85020-5251
US

IV. Provider business mailing address

7227 N 16TH ST SUITE 219
PHOENIX AZ
85020-5251
US

V. Phone/Fax

Practice location:
  • Phone: 602-216-6900
  • Fax: 602-371-9889
Mailing address:
  • Phone: 602-216-6900
  • Fax: 602-371-9889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number830
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number830
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number830
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number830
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License Number830
License Number StateAZ
# 6
Primary TaxonomyN
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number830
License Number StateAZ
# 7
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number830
License Number StateAZ
# 8
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number830
License Number StateAZ

VIII. Authorized Official

Name: CATHERINE O'CONNELL
Title or Position: OWNER
Credential: PHD
Phone: 602-216-6900