Healthcare Provider Details

I. General information

NPI: 1669687869
Provider Name (Legal Business Name): ROBERT MICHAEL O'CONNOR PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 BROADWAY SUITE 315
SEATTLE WA
98122-4397
US

IV. Provider business mailing address

14464 N.E. 12TH PLACE
BELLEVUE WA
98007-4007
US

V. Phone/Fax

Practice location:
  • Phone: 206-296-5753
  • Fax: 206-296-1892
Mailing address:
  • Phone: 425-747-7493
  • Fax: 206-296-1892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number588
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: