Mary Kimberly O'Connor, LCSW-R

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

R048401-1 Issued in NY

Practice address

14 Elm PL Ste 200
Rye, NY 10580-2951

Phone

(917) 453-2328

NPI assigned

Jan 24, 2013

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Feb 28, 2023 through Feb 28, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• M. Kim O'Connor, LCSW, PLLC

  • Clinical Social Worker
  • Rye, NY
  • NPI 1285215335
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1558051200000",
    "number": "1336487438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 SONN DR",
            "city": "RYE",
            "state": "NY",
            "postal_code": "105802531",
            "telephone_number": "917-453-2328",
            "fax_number": "914-925-9839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14 ELM PL STE 200",
            "city": "RYE",
            "state": "NY",
            "postal_code": "105802951",
            "telephone_number": "917-453-2328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "O'CONNOR",
        "first_name": "MARY",
        "middle_name": "KIMBERLY",
        "name_prefix": "Ms.",
        "credential": "LCSW-R",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-24",
        "last_updated": "2019-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NY",
            "license": "R048401-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gina Ninan, FNP
• Alexa Rae Nolan
• Steven Edward Norman, A.T.C.
• Jessica Solanda Nowillo, D.O.
• Ny State Acupuncture Wellness PLLC
• Holly O'Neill-Melville, LMSW
• Sarah O'Neill, PHD
• Ita O'Sullivan, NP
• Optics by MDB Inc
• Meredith Outwater, SOCIAL WORKER

• Clinical Social Worker in Rye, NY
• Providers in Rye, NY by specialty
• Clinical Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.