MEDICARE: MR. ROBERT J OCONNOR LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PR012412 1	NY

General Provider Information

NPI Number	:	1104970672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROBERT J OCONNOR LCSW

Provider Business Mailing Address
First Line	:	800 BROADWAY AVE
Second Line	:
City	:	HOLBROOK
State	:	NY
Zip	:	11741-4917
Country	:	US
Telephone Number	:	631-567-7689
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 BROADWAY AVE
Second Line	:
City	:	HOLBROOK
State	:	NY
Zip	:	11741-4917
Country	:	US
Telephone Number	:	631-567-7689
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	03/08/2026

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