Organization
TIMOTHY O'CONNOR, L.C.S.W., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TIMOTHY JOSEPH O'CONNOR L.C.S.W. (PRESIDENT)
(954) 776-7176
Entity
Organization
Contact information
Practice address
1919 NE 45TH ST STE 122, FORT LAUDERDALE, FL 33308-5135
(954) 776-7176
(954) 776-7160
Mailing address
1919 NE 45TH ST STE 122, FORT LAUDERDALE, FL 33308-5135
(954) 776-7176
(954) 776-7160
Taxonomy
Speciality
Code
Description
License number
State
261QM0850X
Adult Mental Health Clinic/Center
Primary
SW5622
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7638663
—
FL
Enumeration date
06/08/2013
Last updated
06/08/2013
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