Healthcare Provider Details

I. General information

NPI: 1720595093
Provider Name (Legal Business Name): BRIANNA O'CONNOR LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2018
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3306 WESTFIELD AVE
BALTIMORE MD
21214-1446
US

IV. Provider business mailing address

4415 FOREST VIEW AVE
BALTIMORE MD
21206-1916
US

V. Phone/Fax

Practice location:
  • Phone: 914-500-7988
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26339
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: