=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548592009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELISE OCONNELL LICSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/09/2010
-----------------------------------------------------
Last Update Date | 07/31/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12157 W CEDAR DR STE 200
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80228-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-349-6778
-----------------------------------------------------
Fax | 303-985-7882
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12157 W CEDAR DR STE 200
-----------------------------------------------------
City | LAKEWOOD
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80228-2105
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 773-349-6778
-----------------------------------------------------
Fax | 303-985-7882
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LW60853173
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | CSW09931456
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------