Healthcare Provider Details

I. General information

NPI: 1548592009
Provider Name (Legal Business Name): ELISE OCONNELL LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 07/31/2025
Certification Date: 07/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12157 W CEDAR DR STE 200
LAKEWOOD CO
80228-2105
US

IV. Provider business mailing address

12157 W CEDAR DR STE 200
LAKEWOOD CO
80228-2105
US

V. Phone/Fax

Practice location:
  • Phone: 773-349-6778
  • Fax: 303-985-7882
Mailing address:
  • Phone: 773-349-6778
  • Fax: 303-985-7882

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW60853173
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW09931456
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: