MEDICARE: MR. JOHN ROBERT O'CONNOR LISW, ACSW

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	1041C0700X	Clinical Social Worker	I-0004497	OH

General Provider Information

NPI Number	:	1396874467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN ROBERT O'CONNOR LISW, ACSW

Provider Business Mailing Address
First Line	:	12417 CEDAR RD
Second Line	:	STE 23
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3157
Country	:	US
Telephone Number	:	216-229-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	12417 CEDAR RD
Second Line	:	STE 23
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44106-3157
Country	:	US
Telephone Number	:	216-229-2100
Fax Number	:

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	04/06/2016

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