Healthcare Provider Details

I. General information

NPI: 1013216126
Provider Name (Legal Business Name): JULIE A. O'CONNOR LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE A BRADFORD LCSW

II. Dates (important events)

Enumeration Date: 03/16/2011
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3445 POST RD C/O J. ARTHUR MEMORIAL TRUDEAU CENTER
WARWICK RI
02886-7147
US

IV. Provider business mailing address

3445 POST RD C/O J. ARTHUR MEMORIAL TRUDEAU CENTER
WARWICK RI
02886-7147
US

V. Phone/Fax

Practice location:
  • Phone: 401-739-2700
  • Fax: 401-921-5493
Mailing address:
  • Phone: 401-739-2700
  • Fax: 401-921-5493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW01301
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: