Individual
LISA ANN O'CONNOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BSCASACLL
Contact information
Practice address
835 W MAIN ST, ROCHESTER, NY 14611-2335
(585) 467-2230
(585) 730-6110
Mailing address
2 BROXBOURNE DR, FAIRPORT, NY 14450-1719
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1073614533
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073614533
—
NY
Enumeration date
05/20/2014
Last updated
05/30/2019
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