Healthcare Provider Details

I. General information

NPI: 1265557599
Provider Name (Legal Business Name): OCEANIA CONNOLLEY MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 05/04/2020
Certification Date: 05/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 WARING CT STE A
OCEANSIDE CA
92056-4509
US

IV. Provider business mailing address

5662 CALLE REAL #142
GOLETA CA
93117-2317
US

V. Phone/Fax

Practice location:
  • Phone: 760-305-7528
  • Fax: 760-509-4410
Mailing address:
  • Phone: 805-708-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number28897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: