Healthcare Provider Details

I. General information

NPI: 1831052133
Provider Name (Legal Business Name): PATRICK O'CONNER
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1110 PENDLETON ST STE 2
CINCINNATI OH
45202-8819
US

IV. Provider business mailing address

5710 THOMARIDGE CT
CINCINNATI OH
45248-5033
US

V. Phone/Fax

Practice location:
  • Phone: 413-908-2722
  • Fax:
Mailing address:
  • Phone: 513-335-7042
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2507300
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: