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General NPI Number Information
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NPI Number | 1457873358
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Entity Type | Individual
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Provider Name | BRENDAN JOHN O'CONNOR PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 08/08/2022
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Provider Practice Location Address
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Address Line | 46 W AVON RD STE 302
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City | AVON
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State | CT
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Zip | 06001-3679
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Country | US
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Telephone | 860-707-9115
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Fax |
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Provider Business Mailing Address
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Address Line | 46 W AVON RD STE 302
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City | AVON
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State | CT
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Zip | 06001-3679
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Country | US
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Telephone | 860-707-9115
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 022206
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License Number State | NY
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