Healthcare Provider Details

I. General information

NPI: 1659831956
Provider Name (Legal Business Name): KAITLYN MARY O'CONNOR MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2019
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 WEST SIMSBURY ROAD
CANTON CT
06019-6424
US

IV. Provider business mailing address

65 WEST SIMSBURY ROAD
CANTON CT
06019
US

V. Phone/Fax

Practice location:
  • Phone: 860-810-7224
  • Fax:
Mailing address:
  • Phone: 860-810-7224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7084
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: