Healthcare Provider Details

I. General information

NPI: 1720374879
Provider Name (Legal Business Name): ERIN O'CONNELL ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2011
Last Update Date: 04/15/2020
Certification Date: 04/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 SARANAC DR
WINTER SPRINGS FL
32708-5606
US

IV. Provider business mailing address

644 SARANAC DR
WINTER SPRINGS FL
32708-5606
US

V. Phone/Fax

Practice location:
  • Phone: 904-349-1407
  • Fax:
Mailing address:
  • Phone: 904-349-1407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberSS992
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: