Healthcare Provider Details

I. General information

NPI: 1043994460
Provider Name (Legal Business Name): KATHERINE LAVIN O'CONNELL PH.D., L.PSY.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 130TH AVE NE STE 104
BELLEVUE WA
98005-1770
US

IV. Provider business mailing address

2370 130TH AVE NE STE 104
BELLEVUE WA
98005-1770
US

V. Phone/Fax

Practice location:
  • Phone: 425-628-2820
  • Fax:
Mailing address:
  • Phone: 428-628-2820
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSYC.PY.70056093
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: