Healthcare Provider Details

I. General information

NPI: 1720767296
Provider Name (Legal Business Name): ANNA O'CONNOR LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2023
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1455 NW LEARY WAY STE 400
SEATTLE WA
98107-5138
US

IV. Provider business mailing address

134 N 4TH ST OFC 2010
BROOKLYN NY
11249-3296
US

V. Phone/Fax

Practice location:
  • Phone: 646-450-7748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-43854
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW61407361
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: