Healthcare Provider Details

I. General information

NPI: 1861580268
Provider Name (Legal Business Name): ABBEY O'CONNOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBEY ROBERTS LSW

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 DANVILLE CORNER RD
AUBURN ME
04210-8605
US

IV. Provider business mailing address

901 WASHINGTON AVE SUITE 100
PORTLAND ME
04103-2737
US

V. Phone/Fax

Practice location:
  • Phone: 207-321-2194
  • Fax: 207-871-8656
Mailing address:
  • Phone: 207-871-1200
  • Fax: 207-871-1232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC14136
License Number StateME
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberLS10045
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: