Healthcare Provider Details

I. General information

NPI: 1669288833
Provider Name (Legal Business Name): RYAN G. O'CONNELL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 03/29/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CHURCH ST
ARLINGTON VT
05250-4457
US

IV. Provider business mailing address

1457 BAKER AVE
SCHENECTADY NY
12309-5222
US

V. Phone/Fax

Practice location:
  • Phone: 802-375-6566
  • Fax: 802-375-6828
Mailing address:
  • Phone: 631-690-7023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number089.0136504
License Number StateVT
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098950
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number098950-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: