Healthcare Provider Details

I. General information

NPI: 1043885387
Provider Name (Legal Business Name): ROSA MARIA O'CONNOR BA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2021
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3036 PERKINS CT
EUREKA CA
95501-7517
US

IV. Provider business mailing address

7901 4TH ST N STE 300
ST PETERSBURG FL
33702-4399
US

V. Phone/Fax

Practice location:
  • Phone: 413-214-2263
  • Fax:
Mailing address:
  • Phone: 413-214-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number015638
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: