Provider Demographics
NPI:1679793228
Name:OCONNOR, LORRAINE (LCSW)
Entity type:Individual
Prefix:
First Name:LORRAINE
Middle Name:
Last Name:OCONNOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2260 DWYER AVE
Mailing Address - Street 2:
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13501-1102
Mailing Address - Country:US
Mailing Address - Phone:315-714-9891
Mailing Address - Fax:315-724-9896
Practice Address - Street 1:1500 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-5104
Practice Address - Country:US
Practice Address - Phone:315-735-9501
Practice Address - Fax:315-735-9769
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0606411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY060641Medicare ID - Type UnspecifiedLCSW