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General NPI Number Information
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NPI Number | 1467134924
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Entity Type | Individual
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Provider Name | MADISON O'CONNOR LGSW
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Gender | Female
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Dates
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Enumeration Date | 08/03/2023
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Last Update Date | 08/03/2023
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Provider Practice Location Address
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Address Line | 611 PENNSYLVANIA AVE SE # 415
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City | WASHINGTON
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State | DC
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Zip | 20003-4303
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Country | US
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Telephone | 512-608-8278
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Fax |
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Provider Business Mailing Address
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Address Line | 6024 ARCHSTONE CT APT 301
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City | ALEXANDRIA
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State | VA
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Zip | 22310-5535
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Country | US
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Telephone | 512-608-8278
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LG200002626
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License Number State | DC
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