Provider Demographics
NPI:1679159784
Name:O'CONNOR, SAVANNA (LCMHC)
Entity type:Individual
Prefix:
First Name:SAVANNA
Middle Name:
Last Name:O'CONNOR
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1057
Mailing Address - Street 2:
Mailing Address - City:JERICHO
Mailing Address - State:VT
Mailing Address - Zip Code:05465-1057
Mailing Address - Country:US
Mailing Address - Phone:518-569-3369
Mailing Address - Fax:
Practice Address - Street 1:59 FIELDS LN
Practice Address - Street 2:
Practice Address - City:JERICHO
Practice Address - State:VT
Practice Address - Zip Code:05465-9627
Practice Address - Country:US
Practice Address - Phone:518-569-3369
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-19
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT068.0134305101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health