Healthcare Provider Details

I. General information

NPI: 1720041163
Provider Name (Legal Business Name): O'CONNELL W. CASE L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 01/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 N MONROE ST
BLOOMINGTON IN
47404-3321
US

IV. Provider business mailing address

803 N MONROE ST
BLOOMINGTON IN
47404-3321
US

V. Phone/Fax

Practice location:
  • Phone: 812-332-1262
  • Fax: 812-334-8464
Mailing address:
  • Phone: 812-332-1262
  • Fax: 812-334-8464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904005231
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34006579A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: