Active NPI
Kim A O'Connell, LCSW
- Clinical Social Worker
- Montclair, NJ
National Provider Identifier
1124258140
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 44SC05212100
- Practice address
- 11 South Fullerton Ave
Montclair, NJ 07042 - Phone
- (973) 632-6243
- NPI assigned
- Jul 24, 2009
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 44SC05212100 | NJ | Primary |
Addresses
Primary practice location
11 South Fullerton Ave
Montclair, NJ 07042
Mailing address
90 Park St
Montclair, NJ 07042-2929
Phone (973) 632-6243
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 44SC05212100 | NJ | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248393600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1248393600000",
"number": "1124258140",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "90 PARK ST",
"city": "MONTCLAIR",
"state": "NJ",
"postal_code": "070422929",
"telephone_number": "973-632-6243"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11 SOUTH FULLERTON AVE",
"city": "MONTCLAIR",
"state": "NJ",
"postal_code": "07042",
"telephone_number": "973-632-6243"
}
],
"practiceLocations": [],
"basic": {
"last_name": "O'CONNELL",
"first_name": "KIM",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2009-07-24",
"last_updated": "2009-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NJ",
"license": "44SC05212100",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Montclair, NJ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.