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NPI Code Detail

MEDICARE: AMY L O'CONNELL LCSW

MEDICARE: AMY L O'CONNELL 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
11041C0700XClinical Social WorkerCSW.00001876CO

General Provider Information

NPI Number : 1306247820
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMY L O'CONNELL LCSW
Provider Business Mailing Address
First Line : 125 CRESTRIDGE ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80525-3934
Country : US
Telephone Number : 970-494-9761
Fax Number :
Provider Business Practice Location Address
First Line : 242 CONIFER ST
Second Line :
City : FORT COLLINS
State : CO
Zip : 80524-2043
Country : US
Telephone Number : 970-494-9761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2014
Last Update Date : 09/16/2014

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Directions to “ AMY L O'CONNELL LCSW” Practice Location

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